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General NPI Number Information
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NPI Number | 1295717940
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Entity Type | Individual
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Provider Name | BILLY J MITCHELL JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 668 FALLS BLVD N
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City | WYNNE
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State | AR
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Zip | 72396-2614
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Country | US
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Telephone | 870-238-3535
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Fax | 870-238-2427
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Provider Business Mailing Address
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Address Line | 668 FALLS BLVD N
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City | WYNNE
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State | AR
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Zip | 72396-2614
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Country | US
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Telephone | 870-238-3535
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Fax | 870-238-2427
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AR2426
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License Number State | AR
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