=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831383892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH MITCHELL EYECARE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2007
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 BAPTIST DR STE 220
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-985-9120
-----------------------------------------------------
Fax | 601-985-9122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 BAPTIST DR STE 220
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-985-9120
-----------------------------------------------------
Fax | 601-985-9122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH WYATT MITCHELL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 601-985-9120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 13902
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------