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General NPI Number Information
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NPI Number | 1154570505
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Entity Type | Individual
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Provider Name | PAUL MICHAEL FLANAGAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 2300 TREASURY DR SE
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City | CLEVELAND
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State | TN
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Zip | 37323-7185
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Country | US
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Telephone | 423-472-3484
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Fax |
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Provider Business Mailing Address
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Address Line | 9675 ROOKWOOD CIR
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City | OOLTEWAH
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State | TN
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Zip | 37363-1024
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Country | US
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Telephone | 574-514-0855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003537A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2905
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License Number State | TN
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