Healthcare Provider Details

I. General information

NPI: 1982669453
Provider Name (Legal Business Name): DEBORAH CLOWERS FLANAGAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 CENTRAL AVE
ST PETERSBURG FL
33707-1941
US

IV. Provider business mailing address

4940 CENTRAL AVE
ST PETERSBURG FL
33707-1941
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-6600
  • Fax: 727-321-8300
Mailing address:
  • Phone: 727-321-6600
  • Fax: 727-321-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1713
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC1713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: