MEDICARE: DR. NORMA JEANNE FLACK D.O.

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
1	207W00000X	Ophthalmology Physician	OS7904	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4284289	OTHER	FL	AETNA
2	49486	OTHER	FL	BCBS INDIVIDUAL
3	285414	OTHER	FL	COMPBENEFITS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326010166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMA JEANNE FLACK D.O.

Provider Business Mailing Address
First Line	:	P.O. BOX 39209
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33339
Country	:	US
Telephone Number	:	954-851-9966
Fax Number	:	954-318-7360

Provider Business Practice Location Address
First Line	:	2334 NE 53RD STREET
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-776-0292
Fax Number	:	954-776-1442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/24/2021

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