Healthcare Provider Details

I. General information

NPI: 1700864089
Provider Name (Legal Business Name): WILLIAM JOHN FLYNN M.D., O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 FREDERICKSBURG RD SUITE 100
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

5430 FREDERICKSBURG RD SUITE 100
SAN ANTONIO TX
78229-3539
US

V. Phone/Fax

Practice location:
  • Phone: 210-340-1212
  • Fax: 210-525-9617
Mailing address:
  • Phone: 210-340-1212
  • Fax: 210-525-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberM0722
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM0722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: