Provider Demographics
NPI:1720115108
Name:MITCHELL, ROMEA EVANTY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROMEA
Middle Name:EVANTY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ROMEA
Other - Middle Name:EVANTY
Other - Last Name:HARRISBAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 421719
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-1719
Mailing Address - Country:US
Mailing Address - Phone:713-775-0428
Mailing Address - Fax:281-469-7114
Practice Address - Street 1:11115 MCCRACKEN LN
Practice Address - Street 2:SUITE A
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4487
Practice Address - Country:US
Practice Address - Phone:281-469-7610
Practice Address - Fax:281-469-7114
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7002T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612958Medicare PIN
TX0A3321Medicare PIN