Provider Demographics
NPI:1073503983
Name:CADY, MICHAEL T (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:CADY
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 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:1089 W GRANADA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8299
Practice Address - Country:US
Practice Address - Phone:386-676-1300
Practice Address - Fax:386-672-5073
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC01201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084976600Medicaid
FL19286ZMedicare PIN
FL19286WMedicare PIN
FLT84091Medicare UPIN
FL19286YMedicare PIN