Provider Demographics
NPI:1780961755
Name:MITCHELL, KARA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1012
Mailing Address - Country:US
Mailing Address - Phone:614-846-5750
Mailing Address - Fax:614-846-6063
Practice Address - Street 1:6510 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1012
Practice Address - Country:US
Practice Address - Phone:614-846-5750
Practice Address - Fax:614-846-6063
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS6778156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician