MEDICARE: DR. DAVID A MITCHELL 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	OPT734	ME

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

General Provider Information

NPI Number	:	1659404192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A MITCHELL OD

Provider Business Mailing Address
First Line	:	12 W MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1231
Country	:	US
Telephone Number	:	207-834-3124
Fax Number	:	207-834-3127

Provider Business Practice Location Address
First Line	:	12 W MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1231
Country	:	US
Telephone Number	:	207-834-3124
Fax Number	:	207-834-3127

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/22/2008

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