Provider Demographics
NPI:1386814796
Name:BILLY J. MITCHELL JR
Entity Type:Organization
Organization Name:BILLY J. MITCHELL JR
Other - Org Name:MITCHELL EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:870-238-3535
Mailing Address - Street 1:668 FALLS BLVD N
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-2614
Mailing Address - Country:US
Mailing Address - Phone:870-238-3535
Mailing Address - Fax:870-238-2427
Practice Address - Street 1:668 FALLS BLVD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2614
Practice Address - Country:US
Practice Address - Phone:870-238-3535
Practice Address - Fax:870-238-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2426332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0872050001Medicare NSC