Organization
MICHAEL R FLANDRO OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL REESE FLANDRO O.D. (OWNER/PRESIDENT)
(208) 232-6675
Entity
Organization
Contact information
Practice address
360 S ARTHUR AVE, POCATELLO, ID 83204-3307
(208) 232-6675
(208) 232-5800
Mailing address
360 S ARTHUR AVE, POCATELLO, ID 83204-3307
(208) 232-6675
(208) 232-5800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ODP-702
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015363
REGENCE BLUE SHIELD OF IDAHO
ID
05
—
002622900
—
ID
01
—
410039268
MEDICARE RAILROAD RETIREMENT BOARD
ID
01
—
V2811
BLUE CROSS OF IDAHO
ID
Enumeration date
09/16/2008
Last updated
07/21/2009
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