Provider Demographics
NPI:1689863060
Name:DR ROBERT F FLAGEL OPTOMETRIST INC
Entity Type:Organization
Organization Name:DR ROBERT F FLAGEL OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-423-0941
Mailing Address - Street 1:112 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5104
Mailing Address - Country:US
Mailing Address - Phone:513-423-0941
Mailing Address - Fax:513-423-0840
Practice Address - Street 1:112 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5104
Practice Address - Country:US
Practice Address - Phone:513-423-0941
Practice Address - Fax:513-423-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2730/T770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2334478Medicaid
OH2334478Medicaid
OH0279240001Medicare NSC
OH9319901Medicare PIN