Provider Demographics
NPI:1366613929
Name:FLANAGAN, JODI L (OD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 FM 78, STE. A
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1043
Mailing Address - Country:US
Mailing Address - Phone:210-666-3700
Mailing Address - Fax:210-666-3744
Practice Address - Street 1:1117 RIVERTREE DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2424
Practice Address - Country:US
Practice Address - Phone:830-625-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4744TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist