MEDICARE: BILLY J MITCHELL JR. O.D.

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	AR2426	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	71075844972396A001	OTHER	AR	WPS TRICARE SOUTH
3	48809	OTHER	AR	AR BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1295717940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY J MITCHELL JR. O.D.

Provider Business Mailing Address
First Line	:	668 FALLS BLVD N
Second Line	:
City	:	WYNNE
State	:	AR
Zip	:	72396-2614
Country	:	US
Telephone Number	:	870-238-3535
Fax Number	:	870-238-2427

Provider Business Practice Location Address
First Line	:	668 FALLS BLVD N
Second Line	:
City	:	WYNNE
State	:	AR
Zip	:	72396-2614
Country	:	US
Telephone Number	:	870-238-3535
Fax Number	:	870-238-2427

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	01/13/2011

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