Provider Demographics
NPI:1952301475
Name:FIELDING, BRADLEY WILLIAM
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:FIELDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S LITTLER AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3823
Mailing Address - Country:US
Mailing Address - Phone:405-341-3567
Mailing Address - Fax:405-359-2000
Practice Address - Street 1:13 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5206
Practice Address - Country:US
Practice Address - Phone:405-341-3567
Practice Address - Fax:405-359-2000
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763620AMedicaid
OKT40440Medicare UPIN
OK100763620AMedicaid