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General NPI Number Information
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NPI Number | 1407309628
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Entity Type | Individual
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Provider Name | WILLIAM MITCHELL
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Gender | Male
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 450 HIGHWAY 12 W STE D
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City | STARKVILLE
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State | MS
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Zip | 39759-3697
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Country | US
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Telephone | 601-670-1834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 59
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City | STARKVILLE
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State | MS
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Zip | 39760-0059
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Country | US
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Telephone | 662-546-4306
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Fax |
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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 | 945
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License Number State | MS
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