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General NPI Number Information
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NPI Number | 1215014832
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Entity Type | Organization
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Legal Business Name | ALLEGANY OPTICAL LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 12916 CONAMAR DR STE. 104
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City | HAGERSTOWN
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State | MD
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Zip | 21742-2760
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Country | US
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Telephone | 301-733-4944
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Fax | 301-733-5220
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Provider Business Mailing Address
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Address Line | 19336 LEITERSBURG PIKE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1436
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Country | US
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Telephone | 301-582-0675
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Fax | 301-582-3293
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Authorized Official
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Title or Position | OD / MANAGING MEMBER
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Name | DR. PATRICK MILLS FLEMING
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Credential | OD
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Telephone | 304-267-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 21237249
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License Number State | MD
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