Healthcare Provider Details

I. General information

NPI: 1457695033
Provider Name (Legal Business Name): FLYNN OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N MIDDLETOWN RD SUITE 2 B
PEARL RIVER NY
10965-1188
US

IV. Provider business mailing address

275 N MIDDLETOWN RD SUITE 2 B
PEARL RIVER NY
10965-1188
US

V. Phone/Fax

Practice location:
  • Phone: 845-735-5757
  • Fax: 845-735-5967
Mailing address:
  • Phone: 845-735-5757
  • Fax: 845-735-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5469
License Number StateNY

VIII. Authorized Official

Name: KATHY CROTTA
Title or Position: BILLER
Credential:
Phone: 845-735-5757