Provider Demographics
NPI:1174505143
Name:MITCHELL, RAMONA D (OD)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-0420
Mailing Address - Country:US
Mailing Address - Phone:641-236-4002
Mailing Address - Fax:641-236-8687
Practice Address - Street 1:208 WEST ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2014
Practice Address - Country:US
Practice Address - Phone:641-236-4002
Practice Address - Fax:641-236-8687
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51707OtherWELLMARK BC/BS
IA1102269Medicaid
IA73375OtherCOVENTRY
IA232577OtherMIDLANDS CHOICE
IA51707OtherWELLMARK BC/BS
IAU43894Medicare UPIN
IA73375OtherCOVENTRY