Provider Demographics
NPI:1871524611
Name:FLEMING, DOUGLAS O (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:O
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 1:940 SYLVA LN STE H
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-4123
Mailing Address - Fax:209-532-6749
Practice Address - Street 1:940 SYLVA LN STE H
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-4123
Practice Address - Fax:209-532-6749
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9525T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000290Medicaid
CAGSD000290Medicaid
CAU13338Medicare UPIN