Provider Demographics
NPI:1982629135
Name:FLEMING, DANIEL M (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:FLEMING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ROYAL PALM PT
Mailing Address - Street 2:#102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4253
Mailing Address - Country:US
Mailing Address - Phone:772-562-7002
Mailing Address - Fax:772-567-5683
Practice Address - Street 1:89 ROYAL PALM PT
Practice Address - Street 2:#102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4253
Practice Address - Country:US
Practice Address - Phone:772-562-7002
Practice Address - Fax:772-567-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP00001916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T93919Medicare UPIN
19123Medicare ID - Type Unspecified