Provider Demographics
NPI:1366463275
Name:ACHONG-COAN, ROXANNE (OD)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:ACHONG-COAN
Suffix:
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 1:10101 W COLONIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4213
Mailing Address - Country:US
Mailing Address - Phone:407-445-5170
Mailing Address - Fax:407-299-5036
Practice Address - Street 1:10101 W COLONIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4213
Practice Address - Country:US
Practice Address - Phone:407-445-5170
Practice Address - Fax:407-299-5036
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP 3204152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU88484Medicare UPIN
FL20998ZMedicare PIN