Provider Demographics
NPI:1952173197
Name:FIELDS, ZACHARY (ABOC, NCLEC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 SE MONROE ST APT 7931
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1441
Mailing Address - Country:US
Mailing Address - Phone:682-307-9401
Mailing Address - Fax:
Practice Address - Street 1:10000 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-2304
Practice Address - Country:US
Practice Address - Phone:503-788-4761
Practice Address - Fax:503-788-4763
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM246012156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician