Provider Demographics
NPI:1477683001
Name:DRS. MILLER & FLYNN, OPTOMETRISTS LLC
Entity Type:Organization
Organization Name:DRS. MILLER & FLYNN, OPTOMETRISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DUNNE
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:803-799-7358
Mailing Address - Street 1:2757 LAUREL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2037
Mailing Address - Country:US
Mailing Address - Phone:803-799-7358
Mailing Address - Fax:803-799-3919
Practice Address - Street 1:2757 LAUREL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2037
Practice Address - Country:US
Practice Address - Phone:803-799-7358
Practice Address - Fax:803-799-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9752Medicaid
SCT240178001OtherNSC
SC0239370001OtherDME
SC8001Medicare UPIN