Basic Information
Provider Information
NPI: 1265613525
EntityType: 2
ReplacementNPI:  
OrganizationName: DR. PATRICK FLEMING PLLC ALLEGANY OPTOMETRY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ALLEGANY OPTOMETRY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1047 EDWARDS FERRY RD NE
Address2:  
City: LEESBURG
State: VA
PostalCode: 201763347
CountryCode: US
TelephoneNumber: 7037377798
FaxNumber: 7037377889
Practice Location
Address1: 1047 EDWARDS FERRY RD NE
Address2:  
City: LEESBURG
State: VA
PostalCode: 201763347
CountryCode: US
TelephoneNumber: 7037377798
FaxNumber: 7037377889
Other Information
ProviderEnumerationDate: 11/15/2007
LastUpdateDate: 11/15/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FLEMING
AuthorizedOfficialFirstName: PATRICK
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: O.D. / MANAGING MEMBER
AuthorizedOfficialTelephone: 3042679911
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: O.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X4319VAY193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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