Basic Information
| Provider Information | |||||||||
| NPI: | 1851308365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HBP G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059752020 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HBP G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059752020 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-727-TA-423 | AL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000035146 | 05 | AL | MEDICAID | 09338263 | 05 | MS | MEDICAID | 410042854 | 01 | AL | RR MEDICARE | OTHER | A1716 636005396 | 01 | AL | VISION SERVIVES PLAN | OTHER | U46062 | 01 | AL | VIVA HEALTH | OTHER | 051035146 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |