Healthcare Provider Details

I. General information

NPI: 1952582207
Provider Name (Legal Business Name): ALLEGANY OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 SOMERSET BLVD
CHARLES TOWN WV
25414-5625
US

IV. Provider business mailing address

838 SOMERSET BLVD
CHARLES TOWN WV
25414-5625
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-4828
  • Fax: 304-725-4217
Mailing address:
  • Phone: 304-725-4828
  • Fax: 304-725-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1045-5379
License Number StateWV

VIII. Authorized Official

Name: DR. PATRICK M FLEMING
Title or Position: O.D. / MANAGING MEMBER
Credential: O.D.
Phone: 304-267-9911