=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427112010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK FLANAGAN OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 SIGNAL HILLS CTR
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55118-2309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-451-7232
-----------------------------------------------------
Fax | 651-450-6406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11103 WEST AVE SUITE 6
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-524-6663
-----------------------------------------------------
Fax | 210-524-6587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1692
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------