Provider Demographics
NPI:1851504351
Name:MITCHELL EYE INSTITUTE PC
Entity Type:Organization
Organization Name:MITCHELL EYE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-2027
Mailing Address - Street 1:8200 WISCONSIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3127
Mailing Address - Country:US
Mailing Address - Phone:301-656-2027
Mailing Address - Fax:301-656-9690
Practice Address - Street 1:8200 WISCONSIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3127
Practice Address - Country:US
Practice Address - Phone:301-656-2027
Practice Address - Fax:301-656-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01074Medicare PIN
MDC47298Medicare UPIN