Provider Demographics
NPI:1104969161
Name:ROKANAS, NICHOLAOS G (OD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAOS
Middle Name:G
Last Name:ROKANAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3329
Mailing Address - Country:US
Mailing Address - Phone:561-276-5099
Mailing Address - Fax:561-274-9697
Practice Address - Street 1:1715 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3329
Practice Address - Country:US
Practice Address - Phone:561-276-5099
Practice Address - Fax:561-274-9697
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3163152W00000X
NYTUV007654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04057645Medicaid
FL92040288561Medicaid
FL92040288561Medicaid
NY04057645Medicaid