Provider Demographics
NPI:1659349686
Name:FLEISCHMANN, WILLIAM ALLEN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:FLEISCHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:ALLEN
Other - Last Name:FLEISCHMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6716 RIO LINDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-3347
Mailing Address - Country:US
Mailing Address - Phone:916-991-8444
Mailing Address - Fax:916-991-8111
Practice Address - Street 1:6716 RIO LINDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-3347
Practice Address - Country:US
Practice Address - Phone:916-991-8444
Practice Address - Fax:916-991-8111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8227T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082270Medicaid
CASD0082270Medicaid
SD0082270Medicare ID - Type Unspecified