Provider Demographics
NPI:1598712515
Name:FLECK, AMY MARIE (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:FLECK
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 1:111 E CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0412
Mailing Address - Country:US
Mailing Address - Phone:701-222-1420
Mailing Address - Fax:701-255-2414
Practice Address - Street 1:111 E CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0412
Practice Address - Country:US
Practice Address - Phone:701-222-1420
Practice Address - Fax:701-255-2414
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410032423OtherRAILROAD MEDICARE
14808OtherELGIN BCBS MEDICARE
220600001OtherCIGNA DMERC
604796OtherND SOCIAL SERVICE
ND60496Medicaid
14091OtherBCBS MEDICARE
800530OtherND VISION BCBS
MF0331885OtherDEA #S
ND220600001Medicare PIN
ND410032423Medicare PIN
14091OtherBCBS MEDICARE
410032423OtherRAILROAD MEDICARE
14091Medicare ID - Type Unspecified