Healthcare Provider Details

I. General information

NPI: 1528279650
Provider Name (Legal Business Name): ERIC KYLE FLEMING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 DENTON HWY
WATAUGA TX
76148-2464
US

IV. Provider business mailing address

8000 DENTON HWY
WATAUGA TX
76148-2464
US

V. Phone/Fax

Practice location:
  • Phone: 817-581-0866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5637T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: