Provider Demographics
NPI:1972581098
Name:FLICKNER, CHRISTIAN JAMES (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAMES
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 LANE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-424-0831
Practice Address - Fax:831-424-4994
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12884T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MF1269794OtherDEA
MF1269794OtherDEA
V06296Medicare UPIN
SD0128840Medicare ID - Type Unspecified