Provider Demographics
NPI:1770918443
Name:FIELD OF VISION OPTICAL CENTER
Entity type:Organization
Organization Name:FIELD OF VISION OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-864-2242
Mailing Address - Street 1:10565 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-9577
Mailing Address - Country:US
Mailing Address - Phone:304-864-2242
Mailing Address - Fax:304-864-2250
Practice Address - Street 1:10565 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-9577
Practice Address - Country:US
Practice Address - Phone:304-864-2242
Practice Address - Fax:304-864-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3202012000Medicaid