=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073595906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODERICK D FIELDS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9359 TAYLOR PL
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-867-8311
-----------------------------------------------------
Fax | 228-460-5099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9359 TAYLOR PL
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-867-8311
-----------------------------------------------------
Fax | 228-460-5099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 421
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------