Provider Demographics
NPI:1548378532
Name:FIELDS, CHRIS R (OD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:R
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 1:410 MIRACLE MILE PLAZA
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-448-2575
Mailing Address - Fax:603-448-2710
Practice Address - Street 1:410 MIRACLE MILE PLAZA
Practice Address - Street 2:SUITE 13
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-2575
Practice Address - Fax:603-448-2710
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0696152W00000X
VT0300000299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30350494Medicaid
VT0RE5453Medicaid
U65762Medicare UPIN
VT0RE5453Medicaid