Provider Demographics
NPI:1033192133
Name:FLEMING, JOHN C (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FLEMING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9628 CAMPO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1245
Mailing Address - Country:US
Mailing Address - Phone:619-463-9318
Mailing Address - Fax:619-463-9640
Practice Address - Street 1:9628 CAMPO RD
Practice Address - Street 2:SUITE C
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1245
Practice Address - Country:US
Practice Address - Phone:619-463-9318
Practice Address - Fax:619-463-9640
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8461 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4079022Medicaid
CAOP8461Medicare ID - Type Unspecified
CA0590430001Medicare NSC
CA4079022Medicaid
CAU25831Medicare UPIN