MEDICARE: DR. STEPHEN F FLYNN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3341T	TX

General Provider Information

NPI Number	:	1104992130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN F FLYNN O.D.

Provider Business Mailing Address
First Line	:	4115 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5534
Country	:	US
Telephone Number	:	214-821-1655
Fax Number	:	214-823-3403

Provider Business Practice Location Address
First Line	:	4115 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5534
Country	:	US
Telephone Number	:	214-821-1655
Fax Number	:	214-823-3403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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