Provider Demographics
NPI:1326010166
Name:FLACK, NORMA JEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:JEANNE
Last Name:FLACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:2334 NE 53RD STREET
Practice Address - Street 2:
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-776-0292
Practice Address - Fax:954-776-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7904207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4284289OtherAETNA
FL49486OtherBCBS INDIVIDUAL
FL285414OtherCOMPBENEFITS
FL49486OtherBCBS INDIVIDUAL
FLC78947Medicare UPIN
C78947Medicare UPIN