Provider Demographics
NPI:1043276348
Name:FIELDS, CORY A (OD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:A
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 1:225 CHURCH ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1801
Mailing Address - Country:US
Mailing Address - Phone:608-877-2700
Mailing Address - Fax:608-877-2726
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2700
Practice Address - Fax:608-877-2726
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2943-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043276348Medicaid
WI60156OtherDEAN HEALTH INSURANCE
WI38619900Medicaid
U97233Medicare UPIN
WI085874150Medicare PIN
WI60156OtherDEAN HEALTH INSURANCE
WIP00432255Medicare PIN
WI001747805Medicare PIN