Provider Demographics
NPI:1295818268
Name:MITCHELLVILLE EYE ASSOCIATES
Entity Type:Organization
Organization Name:MITCHELLVILLE EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-336-4040
Mailing Address - Street 1:10476 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1304
Mailing Address - Country:US
Mailing Address - Phone:301-336-4040
Mailing Address - Fax:301-350-6690
Practice Address - Street 1:10476 CAMPUS WAY S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-1304
Practice Address - Country:US
Practice Address - Phone:301-336-4040
Practice Address - Fax:301-350-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty