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1811139462 NPI number — EDWARD MITCHELL JR. LDO

NPI Number: 1811139462
Health Care Provider/Practitioner: EDWARD MITCHELL JR. LDO

Information about “1811139462” NPI (EDWARD MITCHELL JR. LDO) exists in 1811139462 in HTML format HTML  |  1811139462 in plain Text format TXT  |  1811139462 in PDF (Portable Document Format) PDF  |  1811139462 in an XML format XML  formats.

NPI Number : 1811139462 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811139462",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MITCHELL",
    "FirstName": "EDWARD",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": "LDO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4100 S FERDON BLVD STE B5",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CRESTVIEW",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32536-5287",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-758-0474",
    "MailingAddressFaxNumber": "850-682-0057",
    "FirstLinePracticeLocationAddress": "4100 S FERDON BLVD STE B5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CRESTVIEW",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32536-5287",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-758-0474",
    "PracticeLocationAddressFaxNumber": "850-682-0057",
    "EnumerationDate": "03/28/2009",
    "LastUpdateDate": "10/15/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "156FC0801X",
          "TaxonomyName": "Contact Lens Fitter",
          "LicenseNumber": "DO 5539",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "156FX1800X",
          "TaxonomyName": "Optician",
          "LicenseNumber": "DO 5539",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "156FX1800X",
          "TaxonomyName": "Optician",
          "LicenseNumber": "5539",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332H00000X",
          "TaxonomyName": "Eyewear Supplier",
          "LicenseNumber": "DO5539",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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