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NPI Code Detail

MEDICARE: DR. PAUL MICHAEL FLANAGAN O.D.

MEDICARE: DR. PAUL MICHAEL FLANAGAN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist18003537AIN
2152W00000XOptometrist2905TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154570505
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL MICHAEL FLANAGAN O.D.
Provider Business Mailing Address
First Line : 9675 ROOKWOOD CIR
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-1024
Country : US
Telephone Number : 574-514-0855
Fax Number :
Provider Business Practice Location Address
First Line : 2300 TREASURY DR SE
Second Line :
City : CLEVELAND
State : TN
Zip : 37323-7185
Country : US
Telephone Number : 423-472-3484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 04/12/2012

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