Provider Demographics
NPI:1508949355
Name:MITCHELL, JOE R III (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:MITCHELL
Suffix:III
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 1:2558 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2750
Mailing Address - Country:US
Mailing Address - Phone:228-424-0507
Mailing Address - Fax:
Practice Address - Street 1:2681 C T SWITZER SR DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4500
Practice Address - Country:US
Practice Address - Phone:228-385-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS565/94188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087058Medicaid
MS00087058Medicaid
MS410000141Medicare ID - Type Unspecified