Provider Demographics
NPI:1861166241
Name:COMINGDEER FIELDS, TARA (OD)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:COMINGDEER FIELDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14299 RANCH ACRES DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5047
Mailing Address - Country:US
Mailing Address - Phone:918-207-7885
Mailing Address - Fax:
Practice Address - Street 1:CLINTON INDIAN HEALTH CENTER
Practice Address - Street 2:10321 N 2274 RD
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7360
Practice Address - Country:US
Practice Address - Phone:580-331-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK3118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program