Provider Demographics
NPI:1891774311
Name:FLICKNER, JAMES LELAND (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LELAND
Last Name:FLICKNER
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 1:48 W ROMIE LANE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-424-0831
Mailing Address - Fax:831-424-4994
Practice Address - Street 1:48 W ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2317
Practice Address - Country:US
Practice Address - Phone:831-424-0834
Practice Address - Fax:831-424-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058550Medicaid
CASD0058550Medicaid
SD0058550Medicare PIN