Provider Demographics
NPI:1811725625
Name:ROCKWELL, MITCHELL (HAS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 SW SANDPIPER WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2434
Mailing Address - Country:US
Mailing Address - Phone:772-485-7495
Mailing Address - Fax:
Practice Address - Street 1:249 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2701
Practice Address - Country:US
Practice Address - Phone:772-485-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6154156FX1800X
FL5633332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician