Provider Demographics
NPI:1538140637
Name:MITCHELL, THOMAS L (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25022 104TH AVE SE
Mailing Address - Street 2:STE D
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2822
Mailing Address - Country:US
Mailing Address - Phone:253-859-1911
Mailing Address - Fax:253-859-5084
Practice Address - Street 1:25022 104TH AVE SE
Practice Address - Street 2:STE D
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2822
Practice Address - Country:US
Practice Address - Phone:253-859-1911
Practice Address - Fax:253-859-5084
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0D00003501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679601512OtherGROUP NPI