Provider Demographics
NPI:1821390469
Name:JAMES CANCELLARI, OD, PA
Entity Type:Organization
Organization Name:JAMES CANCELLARI, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCELLARI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-920-3712
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:813-920-8531
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078197500Medicaid
FLT84125Medicare UPIN