Provider Demographics
NPI:1679584478
Name:FLEMING, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FLEMING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:621 STATE ROUTE 9 NE
Mailing Address - Street 2:PMB # F3
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8525
Mailing Address - Country:US
Mailing Address - Phone:425-397-3937
Mailing Address - Fax:425-397-3937
Practice Address - Street 1:621 STATE ROUTE 9 NE
Practice Address - Street 2:PMB # F3
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8525
Practice Address - Country:US
Practice Address - Phone:425-397-3937
Practice Address - Fax:425-397-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAWA1709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA150508100000OtherLIFEWISE HEALTH PLANS
WAFL2587OtherBCBS OF WASHINGTON REGENC
WAT92817Medicare UPIN