Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2825 | OH |
NPI | 1003831470 |
---|---|
Provider Name | Dr. Edward T Flinn |
First Address | Miamisburg, OH 45342-4739 |
Second Address | Dayton, OH 45458-1621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000330232 | ANTHEM (01) | OH |
T48806 | (02) | OH |