Individual provider Active NPI

Douglas O Fleming, OD

  • Optometrist
  • Sonora, CA
National Provider Identifier
1871524611
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9525T Issued in CA
Practice address
940 Sylva LN Ste H
Sonora, CA 95370-5969
Phone
(209) 532-4123
Fax
(209) 532-6749
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9525T CA Primary

Addresses

Primary practice location

940 Sylva LN Ste H
Sonora, CA 95370-5969

Mailing address

940 Sylva LN Ste H
Sonora, CA 95370-5969
Phone (209) 532-4123

Other identifiers 1

IdentifierTypeStateIssuer
GSD000290MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091212000009 CA Practitioner - Optometry 9335289966
I20241203003610 TX Practitioner - Optometry 9335289966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

52 S Main St
Angels Camp, CA 95222-9153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9525TCAMDOptometrist
9525CAMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
M a C T Health Board, Incorporated Optometrist Past Accepting new patients
M a C T Health Board Incorporated Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: douglas.fleming.p1@direct.macthealth.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1871524611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 SYLVA LN STE H",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705969",
            "telephone_number": "209-532-4123",
            "fax_number": "209-532-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 SYLVA LN STE H",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705969",
            "telephone_number": "209-532-4123",
            "fax_number": "209-532-6749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEMING",
        "first_name": "DOUGLAS",
        "middle_name": "O",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9525T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD000290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.