Provider Demographics
NPI:1609935899
Name:MITCHELL, TREVER J (OD)
Entity Type:Individual
Prefix:DR
First Name:TREVER
Middle Name:J
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 1:1530 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2334
Mailing Address - Country:US
Mailing Address - Phone:504-943-0070
Mailing Address - Fax:504-943-0072
Practice Address - Street 1:1530 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2334
Practice Address - Country:US
Practice Address - Phone:504-943-0070
Practice Address - Fax:504-943-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1328462T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA117781Medicaid
LA117781Medicaid
LAU89094Medicare UPIN