Provider Demographics
NPI:1235274176
Name:PFLAUMER, MARVIN L (OD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:L
Last Name:PFLAUMER
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 1:201 N CHURCH ST
Mailing Address - Street 2:P O BOX 417
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1848
Mailing Address - Country:US
Mailing Address - Phone:937-845-9444
Mailing Address - Fax:937-845-1151
Practice Address - Street 1:201 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1848
Practice Address - Country:US
Practice Address - Phone:937-845-9444
Practice Address - Fax:937-845-1151
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2835T598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220143OtherUNITED HEALTHCARE
OH311584763028OtherCARESOURCE
OH74386OtherMOLINA
OH0092411Medicaid
OH000000022407OtherANTHEM
OH4638481OtherAETNA
OH2220143OtherUNITED HEALTHCARE
OH4638481OtherAETNA
OHT46190Medicare UPIN