Individual
MR. MICHAEL R FLANDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
360 SOUTH ARTHUR AVE, POCATELLO, ID 83204
(208) 232-6675
(208) 232-5800
Mailing address
360 SOUTH ARTHUR AVE, POCATELLO, ID 83204
(208) 232-6675
(208) 232-5800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP702
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015363
REGENCE BLUE SHIELD OF ID
—
05
—
002622900
—
ID
01
—
0969700001
DMERC
ID
01
—
410039268
RAILROAD MEDICARE
ID
01
—
V2811
BLUE CROSS OF IDAHO
—
Enumeration date
09/14/2006
Last updated
09/13/2013
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