Provider Demographics
NPI:1689654063
Name:FLYNN, KIRK (OD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N MIDDLETOWN RD
Mailing Address - Street 2:2B
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1188
Mailing Address - Country:US
Mailing Address - Phone:845-735-5757
Mailing Address - Fax:
Practice Address - Street 1:275 N MIDDLETOWN RD
Practice Address - Street 2:2B
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1188
Practice Address - Country:US
Practice Address - Phone:845-735-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC04272OtherBCBS
NYP2751574OtherOXFORD
NY484283OtherAETNA
NY1C7781OtherHEALTHNET
0964080001Medicare NSC
NY484283OtherAETNA
NY1C7781OtherHEALTHNET