Provider Demographics
NPI:1982141206
Name:MEI LEE FLEMING OPTOMETRY
Entity Type:Organization
Organization Name:MEI LEE FLEMING OPTOMETRY
Other - Org Name:LUMINANCE VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-601-6568
Mailing Address - Street 1:5 MORAGA VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1156
Mailing Address - Country:US
Mailing Address - Phone:415-601-6568
Mailing Address - Fax:
Practice Address - Street 1:3444 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3912
Practice Address - Country:US
Practice Address - Phone:415-601-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11635T261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty