Provider Demographics
NPI:1336224542
Name:FLEMING, PATRICK MILLS (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MILLS
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 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:304-267-9911
Mailing Address - Fax:304-267-9914
Practice Address - Street 1:910 FOXCROFT AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-9911
Practice Address - Fax:304-267-9914
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV833OD152W00000X
VA0618000554152W00000X
MDTA0950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149842000Medicaid
MD60997201OtherCAREFIRST BCBS
WV0149842000Medicaid
MD60997201OtherCAREFIRST BCBS