Provider Demographics
NPI:1245411586
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 1:910 FOXCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1835
Mailing Address - Country:US
Mailing Address - Phone:304-267-9911
Mailing Address - Fax:304-267-9914
Practice Address - Street 1:910 FOXCROFT AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1835
Practice Address - Country:US
Practice Address - Phone:304-267-9911
Practice Address - Fax:304-267-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0201708000Medicaid
WVCH4518OtherRAILROAD MEDICARE
WV9309191Medicare PIN
WV0201708000Medicaid