Provider Demographics
NPI:1730332099
Name:MCCANN, CHRISTOPHER MARK (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:MCCANN
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 1:4101 HUNTERS PARK LN
Mailing Address - Street 2:STE 400
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-3618
Mailing Address - Country:US
Mailing Address - Phone:407-855-6132
Mailing Address - Fax:407-704-7605
Practice Address - Street 1:4101 HUNTERS PARK LN
Practice Address - Street 2:STE 400
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3618
Practice Address - Country:US
Practice Address - Phone:407-855-6132
Practice Address - Fax:407-704-7605
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4349152W00000X
NC2095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005542900Medicaid
FLDO366WMedicare PIN