Provider Demographics
NPI:1659418531
Name:ROY H. MITTMANN, O.D. AND ASSOCIATES INC.
Entity Type:Organization
Organization Name:ROY H. MITTMANN, O.D. AND ASSOCIATES INC.
Other - Org Name:ROY H. MITTMANN O.D. & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MITTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-378-8784
Mailing Address - Street 1:PO BOX 72756
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8019
Mailing Address - Country:US
Mailing Address - Phone:804-378-8784
Mailing Address - Fax:804-423-5790
Practice Address - Street 1:11500 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 672
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4771
Practice Address - Country:US
Practice Address - Phone:804-378-8784
Practice Address - Fax:804-423-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAOP2564OtherEYEMED GROUP ID