Healthcare Provider Details

I. General information

NPI: 1811818875
Provider Name (Legal Business Name): CHARLES MITCHELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FOURTH ST
LIVERMORE CA
94550-4454
US

IV. Provider business mailing address

294 OLIVINA AVE
LIVERMORE CA
94551-6148
US

V. Phone/Fax

Practice location:
  • Phone: 925-447-3883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: