MEDICARE: DR. PHILIP DUNNE FLYNN IV OD

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	152W00000X	Optometrist	1250	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U91386	OTHER	SC	NSC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0239370001	OTHER	SC	DMEPO

General Provider Information

NPI Number	:	1952370926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP DUNNE FLYNN IV OD

Provider Business Mailing Address
First Line	:	2757 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:	803-779-3719

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:	803-779-3719

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/08/2008

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