Provider Demographics
NPI:1477556843
Name:FLEISHER, GEORGE A (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:FLEISHER
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 1:1268 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1770
Mailing Address - Country:US
Mailing Address - Phone:413-872-5339
Mailing Address - Fax:413-782-3050
Practice Address - Street 1:1268 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1770
Practice Address - Country:US
Practice Address - Phone:413-872-5339
Practice Address - Fax:413-782-3050
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0320757Medicaid
MA0320757Medicaid
MAW1746601Medicare PIN
MAP00018160Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MAW17466Medicare ID - Type Unspecified