Healthcare Provider Details

I. General information

NPI: 1699355586
Provider Name (Legal Business Name): CHANDLER MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CORPORATE BLVD STE 210
NORFOLK VA
23502-4965
US

IV. Provider business mailing address

1160 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-2200
  • Fax: 757-961-2971
Mailing address:
  • Phone: 317-274-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101284829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: