Provider Demographics
NPI:1396964201
Name:THOMAS A. FLYNN, 0.D., A PROFESSIONAL CORP.
Entity type:Organization
Organization Name:THOMAS A. FLYNN, 0.D., A PROFESSIONAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-865-9233
Mailing Address - Street 1:203 WALKER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-1450
Mailing Address - Country:US
Mailing Address - Phone:530-865-9233
Mailing Address - Fax:530-865-2398
Practice Address - Street 1:203 WALKER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1450
Practice Address - Country:US
Practice Address - Phone:530-865-9233
Practice Address - Fax:530-865-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0066581Medicaid
CASD0066581Medicaid
CA0481600002Medicare NSC
CAT10388Medicare UPIN