MEDICARE: MITCHELL EYE CLINIC PA INC

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

General Provider Information

NPI Number	:	1790146249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL EYE CLINIC PA INC

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	:	PRESIDENT
Name	:	BILLY J MITCHELL JR.
Credential	:	OD
Telephone Number	:	870-238-3535

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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Directions to “MITCHELL EYE CLINIC PA INC ” Practice Location

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