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General NPI Number Information
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NPI Number | 1235633199
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Entity Type | Organization
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Legal Business Name | MITCHELL EYE CENTER, PLLC
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 699 E POPLAR AVE
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City | SELMER
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State | TN
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Zip | 38375-1828
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Country | US
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Telephone | 731-610-7317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 833
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City | SELMER
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State | TN
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Zip | 38375-0833
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Country | US
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Telephone | 731-610-7317
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ANDREA JO MITCHELL
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Credential | OD
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Telephone | 731-610-7317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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