Provider Demographics
NPI:1649315318
Name:STEPHEN C. FLEMKE,O.D.,P.A.
Entity type:Organization
Organization Name:STEPHEN C. FLEMKE,O.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FLEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-604-8266
Mailing Address - Street 1:10255 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3201
Mailing Address - Country:US
Mailing Address - Phone:410-666-0610
Mailing Address - Fax:410-666-2146
Practice Address - Street 1:10255 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3201
Practice Address - Country:US
Practice Address - Phone:410-666-0610
Practice Address - Fax:410-666-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA-1053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
442QMedicare UPIN
MDU19266Medicare UPIN