Provider Demographics
NPI:1720098643
Name:DR, STEVE C. MITCHELL, SR.
Entity type:Organization
Organization Name:DR, STEVE C. MITCHELL, SR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:620-223-6440
Mailing Address - Street 1:624 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1317
Mailing Address - Country:US
Mailing Address - Phone:620-223-6440
Mailing Address - Fax:620-223-6988
Practice Address - Street 1:624 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1317
Practice Address - Country:US
Practice Address - Phone:620-223-6440
Practice Address - Fax:620-223-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
KS1106-3332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Not Answered332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST74837Medicare UPIN
KS0005120Medicare ID - Type Unspecified