Healthcare Provider Details

I. General information

NPI: 1700822129
Provider Name (Legal Business Name): STEPHEN SCOTT FLECK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WEST AUGLAIZE ST
WAPAKONETA OH
45895
US

IV. Provider business mailing address

916 W PLUM ST
WAPAKONETA OH
45895-1853
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-3800
  • Fax: 419-738-3899
Mailing address:
  • Phone: 419-738-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT862
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: