Provider Demographics
NPI:1215014832
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:ALLEGANY OPTICAL NATIONAL OPTOMETRY ALLEGANY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-267-9911
Mailing Address - Street 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1436
Mailing Address - Country:US
Mailing Address - Phone:301-582-0675
Mailing Address - Fax:301-582-3293
Practice Address - Street 1:12916 CONAMAR DR
Practice Address - Street 2:STE. 104
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2760
Practice Address - Country:US
Practice Address - Phone:301-733-4944
Practice Address - Fax:301-733-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21237249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LM13OtherCAREFIRST
MDCJ5438OtherRAILROAD MEDICARE
MD010MMedicare PIN
MD1252160010Medicare NSC