Provider Demographics
NPI:1467432724
Name:FLEISHMAN, LEWIS P (OD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:P
Last Name:FLEISHMAN
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 1:107 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3111
Mailing Address - Country:US
Mailing Address - Phone:215-675-1165
Mailing Address - Fax:215-675-6080
Practice Address - Street 1:107 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3111
Practice Address - Country:US
Practice Address - Phone:215-675-1165
Practice Address - Fax:215-675-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004593T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07048516Medicaid
PA0170760001Medicare NSC
PA07048516Medicaid
PA287567Medicare ID - Type Unspecified