Provider Demographics
NPI:1205867660
Name:FLYNN, THOMAS A (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:FLYNN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 WALKER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-9904
Mailing Address - Country:US
Mailing Address - Phone:530-865-9233
Mailing Address - Fax:530-865-2398
Practice Address - Street 1:203 WALKER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-9904
Practice Address - Country:US
Practice Address - Phone:530-865-9233
Practice Address - Fax:530-865-2398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0066580Medicare PIN
T10388Medicare UPIN