Provider Demographics
NPI:1073595906
Name:FIELDS, RODERICK D (OD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:D
Last Name:FIELDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 TAYLOR PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3086
Mailing Address - Country:US
Mailing Address - Phone:228-867-8311
Mailing Address - Fax:228-460-5099
Practice Address - Street 1:9359 TAYLOR PL
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3086
Practice Address - Country:US
Practice Address - Phone:228-867-8311
Practice Address - Fax:228-460-5099
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087640Medicaid
MS410000170Medicare ID - Type Unspecified
MS00087640Medicaid