Provider Demographics
NPI:1952584542
Name:DR. MARK J. FIELDS & ASSOCIATES, P.S.C.
Entity Type:Organization
Organization Name:DR. MARK J. FIELDS & ASSOCIATES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-625-0042
Mailing Address - Street 1:820 EASTERN BYP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2512
Mailing Address - Country:US
Mailing Address - Phone:859-625-0042
Mailing Address - Fax:
Practice Address - Street 1:820 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2512
Practice Address - Country:US
Practice Address - Phone:859-625-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1315DT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty