Provider Demographics
NPI:1104986926
Name:MITCHELL, BILL HAROLD (OD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:HAROLD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1725
Mailing Address - Country:US
Mailing Address - Phone:256-878-9181
Mailing Address - Fax:
Practice Address - Street 1:311 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1725
Practice Address - Country:US
Practice Address - Phone:256-878-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS458TA129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000810024Medicaid
ALT68998Medicare UPIN
AL000059654Medicare ID - Type Unspecified
AL0807990001Medicare NSC