Provider Demographics
NPI:1710127303
Name:MARC S FLESHER O.D. P.A.
Entity Type:Organization
Organization Name:MARC S FLESHER O.D. P.A.
Other - Org Name:EYE-SITE OPTICAL WELLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:FLESHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-753-3375
Mailing Address - Street 1:9304 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6577
Mailing Address - Country:US
Mailing Address - Phone:561-753-3375
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33411-6577
Practice Address - Country:US
Practice Address - Phone:561-753-3375
Practice Address - Fax:561-753-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2274332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL2274OtherMISC INS
FLE99371Medicare UPIN
FLFL2274OtherMISC INS
FL0765780001Medicare NSC