Healthcare Provider Details

I. General information

NPI: 1467432724
Provider Name (Legal Business Name): LEWIS P FLEISHMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N YORK RD
HATBORO PA
19040-3111
US

IV. Provider business mailing address

107 N YORK RD
HATBORO PA
19040-3111
US

V. Phone/Fax

Practice location:
  • Phone: 215-675-1165
  • Fax: 215-675-6080
Mailing address:
  • Phone: 215-675-1165
  • Fax: 215-675-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE004593T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: