Provider Demographics
NPI:1750553053
Name:FLEMKE, STEPHEN C (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:FLEMKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD442QMedicare PIN