Provider Demographics
NPI:1861631830
Name:THERESA C. FLEMING, O.D., P.C.
Entity Type:Organization
Organization Name:THERESA C. FLEMING, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-678-2288
Mailing Address - Street 1:101 NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1618
Mailing Address - Country:US
Mailing Address - Phone:856-678-2288
Mailing Address - Fax:856-678-6466
Practice Address - Street 1:101 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1618
Practice Address - Country:US
Practice Address - Phone:856-678-2288
Practice Address - Fax:856-678-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ4130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U26623Medicare UPIN
NJ1113320001Medicare NSC