Provider Demographics
NPI:1477525608
Name:FLEISCHMANN, THOMAS JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:FLEISCHMANN
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 1:3704 MARCONI AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5338
Mailing Address - Country:US
Mailing Address - Phone:916-971-3937
Mailing Address - Fax:916-971-0872
Practice Address - Street 1:3704 MARCONI AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5304
Practice Address - Country:US
Practice Address - Phone:916-971-3937
Practice Address - Fax:916-971-0872
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP6214T152W00000X
CAMF0730970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062140Medicaid
CA6446030001Medicare NSC
CASD0062140Medicaid