MEDICARE: DR. THOMAS KEVIN FLANAGAN OD

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	OPC001600	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265495212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KEVIN FLANAGAN OD

Provider Business Mailing Address
First Line	:	120 15TH AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4510
Country	:	US
Telephone Number	:	727-895-3443
Fax Number	:	727-895-3247

Provider Business Practice Location Address
First Line	:	3322 DR MARTIN LUTHER KING ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1212
Country	:	US
Telephone Number	:	727-895-3443
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	04/19/2011

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