Provider Demographics
NPI:1295848083
Name:MITCHELL, RICHARD JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 KOHRS ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1229
Mailing Address - Country:US
Mailing Address - Phone:406-494-0805
Mailing Address - Fax:406-494-0806
Practice Address - Street 1:3901 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6802
Practice Address - Country:US
Practice Address - Phone:406-494-0805
Practice Address - Fax:406-494-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT48 1494Medicaid
MTT89286Medicare UPIN