Healthcare Provider Details

I. General information

NPI: 1073549226
Provider Name (Legal Business Name): MITCHELL J MAYO BCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 HOLLOW BROOK DR STE 40
COLORADO SPRINGS CO
80918-1451
US

IV. Provider business mailing address

2155 HOLLOW BROOK DR STE 40
COLORADO SPRINGS CO
80918-1451
US

V. Phone/Fax

Practice location:
  • Phone: 719-272-6416
  • Fax: 719-272-6408
Mailing address:
  • Phone: 719-272-6416
  • Fax: 719-272-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: