=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154639664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORO VALLEY EYECARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 E PUSCH VIEW LN STE 100
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-9245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-229-2010
-----------------------------------------------------
Fax | 520-229-2111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 E PUSCH VIEW LN STE 100
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-9245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-229-2010
-----------------------------------------------------
Fax | 520-229-2111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT BRUCE MITCHELL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 520-229-2010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1535
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------