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General NPI Number Information
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NPI Number | 1023753316
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Entity Type | Individual
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Provider Name | BRYAN JUSTIN FIELDS OD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3801 MALL RD
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City | LEXINGTON
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State | KY
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Zip | 40503-4466
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Country | US
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Telephone | 859-278-5443
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Fax | 859-201-1040
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Provider Business Mailing Address
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Address Line | 3801 MALL RD
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City | LEXINGTON
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State | KY
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Zip | 40503-4466
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Country | US
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Telephone | 859-595-7711
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Fax | 859-277-6332
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2274DT
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License Number State | KY
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