Provider Demographics
NPI:1124289186
Name:FLEMING, PATRICK JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301-0204
Mailing Address - Country:US
Mailing Address - Phone:319-642-3311
Mailing Address - Fax:
Practice Address - Street 1:1022 COURT AVE
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1438
Practice Address - Country:US
Practice Address - Phone:319-642-3311
Practice Address - Fax:319-642-7111
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0202547Medicaid
IA5290990001Medicare NSC
IA0202547Medicaid