MEDICARE: DR. GREGORY A. FIELDING , P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier	1027	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760652507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GREGORY A. FIELDING , P.C.

Provider Business Mailing Address
First Line	:	107 S BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4614
Country	:	US
Telephone Number	:	918-358-2245
Fax Number	:	918-358-5230

Provider Business Practice Location Address
First Line	:	107 S BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4614
Country	:	US
Telephone Number	:	918-358-2245
Fax Number	:	918-358-5230

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY ALLEN FIELDING
Credential	:	O.D
Telephone Number	:	918-358-2245

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	06/09/2011

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