Provider Demographics
NPI:1760652507
Name:DR. GREGORY A. FIELDING , P.C.
Entity Type:Organization
Organization Name:DR. GREGORY A. FIELDING , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-358-2245
Mailing Address - Street 1:107 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-4614
Mailing Address - Country:US
Mailing Address - Phone:918-358-2245
Mailing Address - Fax:918-358-5230
Practice Address - Street 1:107 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4614
Practice Address - Country:US
Practice Address - Phone:918-358-2245
Practice Address - Fax:918-358-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
OK1027332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763630AMedicaid
OK100763630AMedicaid
OKA102725Medicare PIN
OK6207800001Medicare NSC