Individual
RODNEY G FLEMING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 LAFAYETTE AVE, MATTOON, IL 61938-5280
(217) 234-3648
(217) 235-0356
Mailing address
1601 LAFAYETTE AVE, MATTOON, IL 61938-5280
(217) 234-3648
(217) 235-0356
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
466838
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004008
HEALTH ALLIANCE
IL
01
—
118513
HEALTH LINK
IL
01
—
225970
PERSONAL CARE
IL
01
—
371015473
OTHER INS. TAX ID
IL
01
—
466838
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
06/23/2005
Last updated
11/11/2009
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