Provider Demographics
NPI:1649468943
Name:FIELDS FAMILY EYE CARE, KIMBERLY A. FIELDS, OD, PC
Entity type:Organization
Organization Name:FIELDS FAMILY EYE CARE, KIMBERLY A. FIELDS, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-374-1445
Mailing Address - Street 1:625 WARRENTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7000
Mailing Address - Country:US
Mailing Address - Phone:540-374-1445
Mailing Address - Fax:540-374-0431
Practice Address - Street 1:625 WARRENTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7000
Practice Address - Country:US
Practice Address - Phone:540-374-1445
Practice Address - Fax:540-374-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010277281Medicaid
1750320362OtherINDIVIDUAL NPI NUMBER
VA5910070001Medicare NSC
1750320362OtherINDIVIDUAL NPI NUMBER