Provider Demographics
NPI:1548270291
Name:FLICKINGER, THOMAS W (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:FLICKINGER
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3642
Mailing Address - Country:US
Mailing Address - Phone:330-836-3828
Mailing Address - Fax:330-836-3727
Practice Address - Street 1:3040 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3642
Practice Address - Country:US
Practice Address - Phone:330-836-3828
Practice Address - Fax:330-836-3727
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4983/T1853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP1649OtherEYEMED INSURANCE
FL0865553Medicare ID - Type Unspecified
U76026Medicare UPIN
OP1649OtherEYEMED INSURANCE
U76026Medicare UPIN