Provider Demographics
NPI:1295717940
Name:MITCHELL, BILLY J JR (OD)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:J
Last Name:MITCHELL
Suffix:JR
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 1:668 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125581722Medicaid
AR71075844972396A001OtherWPS TRICARE SOUTH
AR48809OtherAR BLUE CROSS BLUE SHIELD
ARU50311Medicare UPIN
AR71075844972396A001OtherWPS TRICARE SOUTH