Provider Demographics
NPI:1568534121
Name:CANCELLARI, JAMES (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CANCELLARI
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 1:7802 CITRUS PARK TOWN CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3178
Mailing Address - Country:US
Mailing Address - Phone:813-920-3712
Mailing Address - Fax:
Practice Address - Street 1:7802 CITRUS PARK TOWN CENTER MALL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3178
Practice Address - Country:US
Practice Address - Phone:813-920-3712
Practice Address - Fax:813-920-8531
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84125Medicare UPIN
FL19430Medicare ID - Type Unspecified