Provider Demographics
NPI:1487834982
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:ALLEGANY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:O.D. / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-267-9911
Mailing Address - Street 1:17301 VALLEY MALL RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6966
Mailing Address - Country:US
Mailing Address - Phone:301-582-1771
Mailing Address - Fax:301-582-4681
Practice Address - Street 1:17301 VALLEY MALL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6966
Practice Address - Country:US
Practice Address - Phone:301-582-1771
Practice Address - Fax:301-582-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09135972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0550035-00,01Medicaid
MDCJ5438OtherRAILROAD MEDICARE
MDLM13ALOtherCAREFIRST BC / BS
MD1252160003Medicare NSC
MDLM13ALOtherCAREFIRST BC / BS