Provider Demographics
NPI:1386850923
Name:THOMAS FLICKINGER OD PHD LLC
Entity Type:Organization
Organization Name:THOMAS FLICKINGER OD PHD LLC
Other - Org Name:FLICKINGER EYE CENTER, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:330-836-3828
Mailing Address - Street 1:3040 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3642
Mailing Address - Country:US
Mailing Address - Phone:330-836-3828
Mailing Address - Fax:330-836-3727
Practice Address - Street 1:3040 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3642
Practice Address - Country:US
Practice Address - Phone:330-836-3828
Practice Address - Fax:330-836-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9326981Medicare PIN