Provider Demographics
NPI:1083647390
Name:SZCZOTKA-FLYNN, LORETTA B (OD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:B
Last Name:SZCZOTKA-FLYNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3601
Practice Address - Fax:216-844-7117
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4389207W00000X
OH43897T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP000369575OtherRAILROAD MEDICARE
OH738108OtherBUCKEYE
OH364068OtherWELLCARE
OH000000127598OtherANTHEM
OH0887474Medicaid
OH000000512670OtherANTHEM
OH0660993OtherAETNA
OH0887474OtherBCMH
OH0887474Medicaid
OH000000127598OtherANTHEM
OH738108OtherBUCKEYE