Provider Demographics
NPI:1629116835
Name:FIELDS, BONNIE L (OD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:FIELDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:331 SOUTH 15TH ST
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672
Mailing Address - Country:US
Mailing Address - Phone:330-938-2647
Mailing Address - Fax:330-938-0092
Practice Address - Street 1:331 SOUTH 15TH ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672
Practice Address - Country:US
Practice Address - Phone:330-938-2647
Practice Address - Fax:330-938-0092
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305584Medicaid
OHFI0421641Medicare ID - Type Unspecified
T46791Medicare UPIN
OH0735020001Medicare PIN