Provider Demographics
NPI:1407021454
Name:FLEMING, ELISSA B (OD)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:B
Last Name:FLEMING
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 1:1798 ROANE STATE HWY
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8305
Mailing Address - Country:US
Mailing Address - Phone:865-882-7470
Mailing Address - Fax:865-882-2738
Practice Address - Street 1:1798 ROANE STATE HWY
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8305
Practice Address - Country:US
Practice Address - Phone:865-882-7470
Practice Address - Fax:865-882-2738
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4187884OtherBLUE CROSS
TNCF9659OtherMEDICARE RAILROAD
TNCF9659OtherMEDICARE RAILROAD
TN3942648Medicare PIN