Provider Demographics
NPI:1720118508
Name:THOMAS FLEISCHMANN
Entity Type:Organization
Organization Name:THOMAS FLEISCHMANN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FLEISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-971-3937
Mailing Address - Street 1:3704 MARCONI AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5338
Mailing Address - Country:US
Mailing Address - Phone:916-971-3937
Mailing Address - Fax:916-971-0872
Practice Address - Street 1:3704 MARCONI AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5338
Practice Address - Country:US
Practice Address - Phone:916-971-3937
Practice Address - Fax:916-971-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10264Medicare UPIN
CA6446030001Medicare NSC