Active NPI
Byron K Fleck, O.D.
- Corneal and Contact Management Optometrist
- Hermantown, MN
National Provider Identifier
1275626731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 2733
- Practice address
- 4740 Mall Drive
Hermantown, MN 55811 - Phone
- (218) 727-1204
- NPI assigned
- Oct 2, 2006
- Last updated
- Aug 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 2733 | MN | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 2788-035 | WI |
Addresses
Primary practice location
4740 Mall Drive
Hermantown, MN 55811
Mailing address
8664 Evergreen LN
Cotton, MN 55724-8109
Phone (218) 482-3284
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128886 | Other | MN | U-CARE |
| 43076 | Other | MN | SPECTERA |
| 647819 | Other | MN | PA BLUE CROSS BLUE SHIELD |
| B25851028756 | Other | WI | PREFERRED ONE |
| 37832 | Other | MN | AVESIS |
| 647819 | Other | WI | BCBS PA |
| 22-03394 | Other | MN | MEDICA |
| 53M11FL | Other | MN | BLUE CROSS BLUE SHIELD |
| B25861028756 | Other | MN | PREFERRED ONE |
| 22-03395 | Other | WI | MEDICA |
| 37024 | Other | WI | AVESIS |
| 16525 | Other | MN | SPECTERA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2733 | MN | MD | Corneal and Contact Management Optometrist |
| 2788-035 | WI | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218585600000",
"number": "1275626731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8664 EVERGREEN LN",
"city": "COTTON",
"state": "MN",
"postal_code": "557248109",
"telephone_number": "218-482-3284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 MALL DRIVE",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "55811",
"telephone_number": "218-727-1204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLECK",
"first_name": "BYRON",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2008-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "MN",
"license": "2733",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "WI",
"license": "2788-035",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U-CARE",
"identifier": "128886",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "43076",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE CROSS BLUE SHIELD",
"identifier": "647819",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "B25851028756",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS",
"identifier": "37832",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PA",
"identifier": "647819",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "22-03394",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "53M11FL",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "B25861028756",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "22-03395",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS",
"identifier": "37024",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "16525",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.