Provider Demographics
NPI:1285813717
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 1:5500 BUCKEYSTOWN PIKE
Mailing Address - Street 2:STE. 876
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8331
Mailing Address - Country:US
Mailing Address - Phone:301-663-4745
Mailing Address - Fax:301-293-0256
Practice Address - Street 1:5500 BUCKEYSTOWN PIKE
Practice Address - Street 2:STE. 876
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8331
Practice Address - Country:US
Practice Address - Phone:301-663-4745
Practice Address - Fax:301-293-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10010880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0550035-00,03Medicaid
MDLM13ALOtherCAREFIRST
MDLM13ALOtherCAREFIRST
MD0550035-00,03Medicaid