MEDICARE: MRS. JENNIFER L FIELD OPTICIAN

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	156FX1800X	Optician

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	:	1356410849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L FIELD OPTICIAN

Provider Business Mailing Address
First Line	:	10565 VETERANS MEMORIAL HWY
Second Line	:
City	:	MASONTOWN
State	:	WV
Zip	:	26542-9577
Country	:	US
Telephone Number	:	304-864-2242
Fax Number	:	304-864-2250

Provider Business Practice Location Address
First Line	:	10565 VETERANS MEMORIAL HIGHWAY
Second Line	:
City	:	MASONTOWN
State	:	WV
Zip	:	26542-9577
Country	:	US
Telephone Number	:	304-864-2242
Fax Number	:	304-864-2250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/29/2009

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