Provider Demographics
NPI:1083905269
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:ALLEGANY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:O.D. / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-267-9911
Mailing Address - Street 1:5405 WILLIAMSPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6495
Mailing Address - Country:US
Mailing Address - Phone:304-263-4000
Mailing Address - Fax:304-263-4004
Practice Address - Street 1:5405 WILLIAMSPORT PIKE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6495
Practice Address - Country:US
Practice Address - Phone:304-263-4000
Practice Address - Fax:304-263-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty