Provider Demographics
NPI:1649260555
Name:CANN, ALFRED H III (OD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:H
Last Name:CANN
Suffix:III
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:32701-4798
Mailing Address - Country:US
Mailing Address - Phone:407-834-7776
Mailing Address - Fax:407-834-0973
Practice Address - Street 1:787 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8325
Practice Address - Country:US
Practice Address - Phone:407-834-7776
Practice Address - Fax:407-834-0973
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084837900Medicaid
FLT84064Medicare UPIN
FL19287ZMedicare PIN
FL19287WMedicare PIN