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General NPI Number Information
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NPI Number | 1326087461
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Entity Type | Individual
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Provider Name | MARK CHANDLER MITCHUM OD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 2648 LEE AVENUE
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City | SANFORD
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State | NC
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Zip | 27332-5950
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Country | US
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Telephone | 919-775-5221
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Fax | 919-775-7655
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Provider Business Mailing Address
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Address Line | 428 CHANDLER GRANT DR
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City | CARY
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State | NC
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Zip | 27519-8838
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Country | US
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Telephone | 336-524-6604
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Fax | 336-524-6579
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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 | 1270
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License Number State | NC
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