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NPI Code Detail

MEDICARE: DR. MICHAEL J FLEMING OD

MEDICARE:  DR. MICHAEL J FLEMING  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristWA1709WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1150508100000OTHERWALIFEWISE HEALTH PLANS
2FL2587OTHERWABCBS OF WASHINGTON REGENC

General Provider Information

NPI Number : 1679584478
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL J FLEMING OD
Provider Business Mailing Address
First Line : 621 STATE ROUTE 9 NE
Second Line : PMB # F3
City : LAKE STEVENS
State : WA
Zip : 98258-8525
Country : US
Telephone Number : 425-397-3937
Fax Number : 425-397-3937
Provider Business Practice Location Address
First Line : 621 STATE ROUTE 9 NE
Second Line : PMB # F3
City : LAKE STEVENS
State : WA
Zip : 98258-8525
Country : US
Telephone Number : 425-397-3937
Fax Number : 425-397-3937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MICHAEL J FLEMING OD” Practice Location

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