Provider Demographics
NPI:1376811448
Name:MITCHELL, DULCY (OD)
Entity type:Individual
Prefix:DR
First Name:DULCY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-5514
Mailing Address - Country:US
Mailing Address - Phone:781-799-0300
Mailing Address - Fax:
Practice Address - Street 1:111 EVERETT AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2380
Practice Address - Country:US
Practice Address - Phone:617-884-0456
Practice Address - Fax:617-884-0457
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDM87167Medicaid
RI002560702Medicare PIN