Provider Demographics
NPI:1376811448
Name:MITCHELL, DULCY (OD)
Entity Type:Individual
Prefix:DR
First Name:DULCY
Middle Name:
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 1:566 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2716
Mailing Address - Country:US
Mailing Address - Phone:401-738-4800
Mailing Address - Fax:401-738-0174
Practice Address - Street 1:7805 POST RD
Practice Address - Street 2:
Practice Address - City:N KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4405
Practice Address - Country:US
Practice Address - Phone:401-294-1010
Practice Address - Fax:401-295-2050
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDM87167Medicaid
RI002560702Medicare PIN