Provider Demographics
NPI:1790861326
Name:FLAIM, JOHN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:FLAIM
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 1:1521 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1102
Mailing Address - Country:US
Mailing Address - Phone:717-733-1575
Mailing Address - Fax:717-733-2189
Practice Address - Street 1:1521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1102
Practice Address - Country:US
Practice Address - Phone:717-733-1575
Practice Address - Fax:717-733-2189
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-006027T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0707340001Medicare NSC
PAFL426058Medicare ID - Type UnspecifiedHGS ADMINISTRATORS
PAT-30359Medicare UPIN