Provider Demographics
NPI:1033472865
Name:FLEMING, PAUL JAMES (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
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 1:14734 YOSEMITE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4907
Mailing Address - Country:US
Mailing Address - Phone:952-270-6130
Mailing Address - Fax:
Practice Address - Street 1:14734 YOSEMITE AVE S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4907
Practice Address - Country:US
Practice Address - Phone:952-270-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist