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1003951294 NPI number — BERTRAM MAURICE MITCHEL O.D.

NPI Number: 1003951294
Health Care Provider/Practitioner: BERTRAM MAURICE MITCHEL O.D.

Information about “1003951294” NPI (BERTRAM MAURICE MITCHEL O.D.) exists in 1003951294 in HTML format HTML  |  1003951294 in plain Text format TXT  |  1003951294 in PDF (Portable Document Format) PDF  |  1003951294 in an XML format XML  formats.

NPI Number : 1003951294 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003951294",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MITCHEL",
    "FirstName": "BERTRAM",
    "MiddleName": "MAURICE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "669 HARRISON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST MEADOW",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11554-4422",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2126 MERRICK MALL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERRICK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11566-3626",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-546-4800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/21/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "TUV002298-1",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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