Provider Demographics
NPI:1790146249
Name:MITCHELL EYE CLINIC PA INC
Entity Type:Organization
Organization Name:MITCHELL EYE CLINIC PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:870-238-3535
Mailing Address - Street 1:668 FALLS BLVD N
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-2614
Mailing Address - Country:US
Mailing Address - Phone:870-238-3535
Mailing Address - Fax:870-238-2427
Practice Address - Street 1:668 FALLS BLVD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2614
Practice Address - Country:US
Practice Address - Phone:870-238-3535
Practice Address - Fax:870-238-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty