Provider Demographics
NPI:1376606780
Name:FLECKENSTEIN, PAIGE E (OD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:E
Last Name:FLECKENSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 US 31 N
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:317-887-2732
Mailing Address - Fax:317-887-1553
Practice Address - Street 1:1251 US 31 N
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:317-887-2732
Practice Address - Fax:317-887-1553
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002978A152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN178880BMedicare ID - Type Unspecified
INU74299Medicare UPIN