Provider Demographics
NPI:1497731764
Name:FIELDS, TIMOTHY REED (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:REED
Last Name:FIELDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2208
Mailing Address - Country:US
Mailing Address - Phone:816-233-5685
Mailing Address - Fax:816-233-8896
Practice Address - Street 1:2320 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2208
Practice Address - Country:US
Practice Address - Phone:816-233-5685
Practice Address - Fax:816-233-8896
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311989701Medicaid
MO0000235Medicare ID - Type Unspecified
MO311989701Medicaid