Provider Demographics
NPI:1972500726
Name:BELCHER, DONNA J II (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:BELCHER
Suffix:II
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SPRUCE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6780
Mailing Address - Country:US
Mailing Address - Phone:386-304-8941
Mailing Address - Fax:
Practice Address - Street 1:1369 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1529
Practice Address - Country:US
Practice Address - Phone:386-761-1323
Practice Address - Fax:386-761-8210
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU74824Medicare UPIN