MEDICARE: DR. STEVE C MITCHELL SR. OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11063	KS
2	152WC0802X	Corneal and Contact Management Optometrist	1106-3	KS
3	152WL0500X	Low Vision Rehabilitation Optometrist	1106-3	KS
4	152WP0200X	Pediatric Optometrist	1106-3	KS
5	152WS0006X	Sports Vision Optometrist	1106-3	KS
6	152WV0400X	Vision Therapy Optometrist	1106-3	KS
7	152WX0102X	Occupational Vision Optometrist	1106-3	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	410014059	OTHER	KS	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	188855	OTHER	KS	COVENTRY HEALTHCARE
2	5120	OTHER	KS	BLUE CROSS BLUE SHIELD
3	23665019	OTHER	KS	BCBS OF KANSAS CITY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	664300	OTHER	KS	FIRST GUARD
7	338790	OTHER	KS	FAMILY HEALTH PARTNERS

General Provider Information

NPI Number	:	1225034713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE C MITCHELL SR. OD

Provider Business Mailing Address
First Line	:	624 S NATIONAL AVE
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-1317
Country	:	US
Telephone Number	:	620-223-6440
Fax Number	:	620-223-6988

Provider Business Practice Location Address
First Line	:	624 S NATIONAL AVE
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-1317
Country	:	US
Telephone Number	:	620-223-6440
Fax Number	:	620-223-6988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	04/13/2010

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Practice Location Address:

624 S NATIONAL AVE
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66701-1317

Practice Phone: 620-223-6440
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66701-1317

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