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General NPI Number Information
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NPI Number | 1306406269
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Entity Type | Individual
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Provider Name | IDELL MARIE MITCHELL O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 550 CONNELL PARK LN
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City | BATON ROUGE
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State | LA
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Zip | 70806-6539
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Country | US
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Telephone | 225-924-2020
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Fax | 225-924-2809
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Provider Business Mailing Address
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Address Line | 550 CONNELL PARK LN
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City | BATON ROUGE
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State | LA
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Zip | 70806-6539
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Country | US
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Telephone | 225-924-2020
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Fax | 225-924-2809
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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 | 1901-837AT
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License Number State | LA
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