Individual provider Active NPI

Thomas Kevin Flanagan, OD

  • Optometrist
  • St Petersburg, FL
National Provider Identifier
1265495212
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC001600 Issued in FL
Practice address
3322 Dr Martin Luther King St N
St Petersburg, FL 33704-1212
Phone
(727) 895-3443
NPI assigned
Apr 10, 2006
Last updated
Apr 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC001600 FL Primary

Addresses

Primary practice location

3322 Dr Martin Luther King St N
St Petersburg, FL 33704-1212

Mailing address

120 15TH Ave NE
St Petersburg, FL 33704-4510
Phone (727) 895-3443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050610000281 FL Practitioner - Optometry 2466496450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Doctors Optical Outlets PAGroup PAC ID 0042123846, 97 clinicians

Practice addresses (Care Compare)

5607 Johns Rd
Tampa, FL 33634-4499
Phone (813) 385-1873

6927 4TH St N
Saint Petersburg, FL 33702-6846
Phone (727) 210-8672

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC001600FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Doctors Optical Outlets PA Optometrist Current Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Dec 23, 2013 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Dec 23, 2013 Accepting new patients

Locations

7 Eagle Ridge Dr
Lake Wales, FL 33859
Phone (863) 676-0911

4590 Park Blvd N
Ste 200
Pinellas Park, FL 33781
Phone (727) 547-4856

6901 22nd Ave N
Rm 760
St Petersburg, FL 33710
Phone (727) 343-3006

6927 4th St N
St Petersburg, FL 33702
Phone (727) 210-8672

5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1265495212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 15TH AVE NE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337044510",
            "telephone_number": "727-895-3443",
            "fax_number": "727-895-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 DR MARTIN LUTHER KING ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337041212",
            "telephone_number": "727-895-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANAGAN",
        "first_name": "THOMAS",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC001600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.