Provider Demographics
NPI:1740509199
Name:MITCHELL, TAMMY S
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N A ST
Mailing Address - Street 2:1008 A STREET
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3202
Mailing Address - Country:US
Mailing Address - Phone:432-288-1681
Mailing Address - Fax:432-218-8933
Practice Address - Street 1:1008 N A ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3202
Practice Address - Country:US
Practice Address - Phone:432-288-1681
Practice Address - Fax:432-218-8933
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician