Provider Demographics
NPI:1023753316
Name:FIELDS, BRYAN JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JUSTIN
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 1:3801 MALL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4466
Mailing Address - Country:US
Mailing Address - Phone:859-595-7711
Mailing Address - Fax:859-277-6332
Practice Address - Street 1:3801 MALL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4466
Practice Address - Country:US
Practice Address - Phone:859-278-5443
Practice Address - Fax:859-201-1040
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2274DT152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist