Provider Demographics
NPI:1043232754
Name:MITCHELL, PAUL C (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4102 OGLETOWN STANTON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4169
Mailing Address - Country:US
Mailing Address - Phone:302-454-8800
Mailing Address - Fax:302-454-8801
Practice Address - Street 1:4102 OGLETOWN STANTON RD
Practice Address - Street 2:STE 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-454-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000866522Medicaid
44212OtherCOVENTRY
DE0000866522Medicaid
DE475020O32Medicare PIN
DEP00443449Medicare PIN