Basic Information
| Provider Information | |||||||||
| NPI: | 1063597276 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR PATRICK FLEMING PLLC ALLEGANY OPTOMETRY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALLEGANY OPTOMETRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19336 LEITERSBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015820675 | ||||||||
| FaxNumber: | 3015823293 | ||||||||
| Practice Location | |||||||||
| Address1: | 2028 S PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407223217 | ||||||||
| FaxNumber: | 5407223219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | MILLS | ||||||||
| AuthorizedOfficialTitleorPosition: | OD OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3042679911 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0603000059 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0870510001 | 01 | MEDICAE NATIONAL SUPPLIER | OTHER |