Provider Demographics
NPI:1720256845
Name:DONALD W. MITCHELL, O.D.
Entity type:Organization
Organization Name:DONALD W. MITCHELL, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-337-5252
Mailing Address - Street 1:25720 COPPER KING WAY
Mailing Address - Street 2:
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2557
Mailing Address - Country:US
Mailing Address - Phone:906-337-5252
Mailing Address - Fax:906-337-5254
Practice Address - Street 1:25720 COPPER KING WAY
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2557
Practice Address - Country:US
Practice Address - Phone:906-337-5252
Practice Address - Fax:906-337-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0258560001Medicare NSC