Provider Demographics
NPI:1811975857
Name:JAMES L FLICKNER
Entity type:Organization
Organization Name:JAMES L FLICKNER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:FLICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-424-0834
Mailing Address - Street 1:48 WEST 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:831-424-0834
Mailing Address - Fax:831-424-4994
Practice Address - Street 1:48 WEST 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:831-424-0834
Practice Address - Fax:831-424-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0859230001Medicare NSC
ZZZ25069ZMedicare PIN