Provider Demographics
NPI:1306976501
Name:AUDREY E. FIELDS, O.D. & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:AUDREY E. FIELDS, O.D. & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-250-6820
Mailing Address - Street 1:1514 BUCCANEER PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-8982
Mailing Address - Country:US
Mailing Address - Phone:701-269-0916
Mailing Address - Fax:
Practice Address - Street 1:107 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3129
Practice Address - Country:US
Practice Address - Phone:701-751-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty