Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35-05-1755-M | OH |
NPI | 1043203045 |
---|---|
Provider Name | David J Mitchell |
First Address | Beachwood, OH 44122-5692 |
Second Address | Beachwood, OH 44122-5692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 24/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0315046 | (05) | OH |
C44873 | (02) | OH |
DS4304 | RAILROAD MEDICARE (01) |