Provider Demographics
NPI:1275626731
Name:FLECK, BYRON K (OD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:K
Last Name:FLECK
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 1:8664 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:COTTON
Mailing Address - State:MN
Mailing Address - Zip Code:55724-8109
Mailing Address - Country:US
Mailing Address - Phone:218-482-3284
Mailing Address - Fax:
Practice Address - Street 1:4740 MALL DRIVE
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-727-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2733152WC0802X
WI2788-035152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB25851028756OtherPREFERRED ONE
MN16525OtherSPECTERA
MN37832OtherAVESIS
MN647819OtherPA BLUE CROSS BLUE SHIELD
MN128886OtherU-CARE
MN22-03394OtherMEDICA
WI22-03395OtherMEDICA
WI647819OtherBCBS PA
MNB25861028756OtherPREFERRED ONE
MN43076OtherSPECTERA
WI37024OtherAVESIS
MN53M11FLOtherBLUE CROSS BLUE SHIELD
MN647819OtherPA BLUE CROSS BLUE SHIELD
MNB25861028756OtherPREFERRED ONE