Provider Demographics
NPI:1750320362
Name:FIELDS, KIMBERLY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name: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 1:625 WARRENTON RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1010
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:STE. 105
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1010
Practice Address - Country:US
Practice Address - Phone:540-374-1445
Practice Address - Fax:540-374-0431
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010277281Medicaid
VAC09790Medicare PIN