Healthcare Provider Details

I. General information

NPI: 1720098643
Provider Name (Legal Business Name): DR, STEVE C. MITCHELL, SR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 S NATIONAL AVE
FORT SCOTT KS
66701-1317
US

IV. Provider business mailing address

624 S NATIONAL AVE
FORT SCOTT KS
66701-1317
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-6440
  • Fax: 620-223-6988
Mailing address:
  • Phone: 620-223-6440
  • Fax: 620-223-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1106-3
License Number StateKS

VIII. Authorized Official

Name: DR. STEVE C MITCHELL SR.
Title or Position: OPTOMETRIST
Credential: OD
Phone: 620-223-6440