Provider Demographics
NPI:1255502670
Name:DR ROBERT C FLEISCHER OD INC
Entity Type:Organization
Organization Name:DR ROBERT C FLEISCHER OD INC
Other - Org Name:KRAUSE OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DR ROBERT C FLEISCHER OD INC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD OPTOMETRIST
Authorized Official - Phone:330-394-8862
Mailing Address - Street 1:1515 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6641
Mailing Address - Country:US
Mailing Address - Phone:330-394-8862
Mailing Address - Fax:330-393-0197
Practice Address - Street 1:1515 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6641
Practice Address - Country:US
Practice Address - Phone:330-394-8862
Practice Address - Fax:330-393-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000321436OtherANTHEM
OH0092680Medicaid
OH281348822003OtherMEDICAL MUTUAL
OH000000321436OtherANTHEM
OH281348822003OtherMEDICAL MUTUAL
OH0238970001Medicare NSC