Provider Demographics
NPI:1679741391
Name:DEBORAH C FLANAGAN OD PA
Entity Type:Organization
Organization Name:DEBORAH C FLANAGAN OD PA
Other - Org Name:EYEWEAR UNIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-321-6600
Mailing Address - Street 1:4940 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1941
Mailing Address - Country:US
Mailing Address - Phone:727-321-6600
Mailing Address - Fax:727-321-8300
Practice Address - Street 1:4940 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1941
Practice Address - Country:US
Practice Address - Phone:727-321-6600
Practice Address - Fax:727-321-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1713152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078307200Medicaid
FL078307200Medicaid
FL0677550001Medicare NSC
FLT54786Medicare UPIN