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General NPI Number Information
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NPI Number | 1639320179
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Entity Type | Organization
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Legal Business Name | MARK G. MITCHELL, OD, LTD.
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 4600 KIETZKE LN STE B119
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City | RENO
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State | NV
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Zip | 89502-5036
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Country | US
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Telephone | 775-825-0506
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Fax | 775-825-0873
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Provider Business Mailing Address
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Address Line | 4600 KIETZKE LN STE B119
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City | RENO
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State | NV
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Zip | 89502-5036
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Country | US
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Telephone | 775-825-0506
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Fax | 775-825-0873
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Authorized Official
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Title or Position | CEO
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Name | DR. MARK MITCHELL
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Credential | OD
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Telephone | 775-825-0506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 374
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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