Provider Demographics
NPI:1700864089
Name:FLYNN, WILLIAM JOHN (MD, OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3539
Mailing Address - Country:US
Mailing Address - Phone:210-340-1212
Mailing Address - Fax:210-525-9617
Practice Address - Street 1:5430 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-340-1212
Practice Address - Fax:210-525-9617
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0722207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M2751OtherBLUE CROSS BLUE SHIELD
TX181794202Medicaid
TX181794201Medicaid
TX8G6967Medicare PIN
TX8M2751OtherBLUE CROSS BLUE SHIELD
TX181794202Medicaid
TX8J6524Medicare PIN