Provider Demographics
NPI:1235240318
Name:TODD D FLADEN MD LLC
Entity Type:Organization
Organization Name:TODD D FLADEN MD LLC
Other - Org Name:THE FLADEN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-489-1441
Mailing Address - Street 1:1330 MERCY DR NW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-489-1441
Mailing Address - Fax:330-489-1410
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 310
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-489-1441
Practice Address - Fax:330-489-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-046190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490777Medicaid
OH0490777Medicaid
OH9343751Medicare PIN