Provider Demographics
NPI:1710929104
Name:DAGGETT, MITCHELL WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:WAYNE
Last Name:DAGGETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6823 GREEN OAKS RD
Mailing Address - Street 2:STE B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1732
Mailing Address - Country:US
Mailing Address - Phone:817-731-4400
Mailing Address - Fax:866-417-3176
Practice Address - Street 1:6823 GREEN OAKS RD
Practice Address - Street 2:STE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1732
Practice Address - Country:US
Practice Address - Phone:817-731-4400
Practice Address - Fax:866-417-3176
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3025TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist