Provider Demographics
NPI:1629237474
Name:CHARLES D FIELD III OD
Entity Type:Organization
Organization Name:CHARLES D FIELD III OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WICKLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-253-3150
Mailing Address - Street 1:701 S OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5929
Mailing Address - Country:US
Mailing Address - Phone:304-253-3150
Mailing Address - Fax:304-252-9087
Practice Address - Street 1:701 S OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5929
Practice Address - Country:US
Practice Address - Phone:304-253-3150
Practice Address - Fax:304-252-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV582-OD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001522821OtherBLUE CROSS BLUE SHIELD
WV0150202000Medicaid
WV0150202000Medicaid
WV0579981Medicare PIN
WVT32403Medicare UPIN