=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194986448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. BONNIE L. FIELDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2008
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 S 15TH ST
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44672-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-938-2647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 278
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44672-0278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-938-2647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BONNIE L. FIELDS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 330-938-2647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------