Provider Demographics
NPI:1225034713
Name:MITCHELL, STEVE C SR (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:C
Last Name:MITCHELL
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:624 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1317
Mailing Address - Country:US
Mailing Address - Phone:620-223-6440
Mailing Address - Fax:620-223-6988
Practice Address - Street 1:624 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1317
Practice Address - Country:US
Practice Address - Phone:620-223-6440
Practice Address - Fax:620-223-6988
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11063152W00000X
KS1106-3152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS188855OtherCOVENTRY HEALTHCARE
KS5120OtherBLUE CROSS BLUE SHIELD
KS23665019OtherBCBS OF KANSAS CITY
KS100090050AMedicaid
KS410014059OtherMEDICARE RAILROAD
KS664300OtherFIRST GUARD
KS338790OtherFAMILY HEALTH PARTNERS
KS23665019OtherBCBS OF KANSAS CITY
KS100090050AMedicaid
KST74837Medicare UPIN
KS005120Medicare ID - Type Unspecified