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General NPI Number Information
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NPI Number | 1659418531
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Entity Type | Organization
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Legal Business Name | ROY H. MITTMANN, O.D. AND ASSOCIATES INC.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 11500 MIDLOTHIAN TPKE SUITE 672
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City | RICHMOND
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State | VA
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Zip | 23235-4771
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Country | US
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Telephone | 804-378-8784
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Fax | 804-423-5790
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Provider Business Mailing Address
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Address Line | PO BOX 72756
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City | RICHMOND
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State | VA
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Zip | 23235-8019
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Country | US
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Telephone | 804-378-8784
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Fax | 804-423-5790
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Authorized Official
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Title or Position | DIRECTOR / PRESIDENT
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Name | DR. ROY H MITTMANN
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Credential | O.D.
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Telephone | 804-378-8784
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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 | 0618000405
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License Number State | VA
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