=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770500241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN LEWIS MITCHELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 11/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22023 ST RD #7 STE 102
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-451-0655
-----------------------------------------------------
Fax | 561-451-2660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22023 ST RD #7 STE #102
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-451-0655
-----------------------------------------------------
Fax | 561-451-2660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME57319
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------