Provider Demographics
NPI:1457695033
Name:FLYNN OPTOMETRY PLLC
Entity Type:Organization
Organization Name:FLYNN OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-735-5757
Mailing Address - Street 1:275 N MIDDLETOWN RD
Mailing Address - Street 2:SUITE 2 B
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1188
Mailing Address - Country:US
Mailing Address - Phone:845-735-5757
Mailing Address - Fax:845-735-5967
Practice Address - Street 1:275 N MIDDLETOWN RD
Practice Address - Street 2:SUITE 2 B
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1188
Practice Address - Country:US
Practice Address - Phone:845-735-5757
Practice Address - Fax:845-735-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C04271Medicare PIN