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General NPI Number Information
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NPI Number | 1952582207
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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 | 11/15/2007
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 838 SOMERSET BLVD
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City | CHARLES TOWN
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State | WV
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Zip | 25414-5625
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Country | US
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Telephone | 304-725-4828
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Fax | 304-725-4217
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Provider Business Mailing Address
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Address Line | 838 SOMERSET BLVD
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City | CHARLES TOWN
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State | WV
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Zip | 25414-5625
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Country | US
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Telephone | 304-725-4828
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Fax | 304-725-4217
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Authorized Official
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Title or Position | O.D. / MANAGING MEMBER
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Name | DR. PATRICK M FLEMING
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Credential | O.D.
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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 | 1045-5379
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License Number State | WV
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