Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 11063 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1106-3 | KS |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 1106-3 | KS |
N | 152WP0200X | Pediatric Optomitrist | 1106-3 | KS |
N | 152WS0006X | Sports Vision | 1106-3 | KS |
N | 152WV0400X | Optomitrist - Vision Therapist | 1106-3 | KS |
N | 152WX0102X | Occupational Vision | 1106-3 | KS |
NPI | 1225034713 |
---|---|
Provider Name | Dr. Steve C Mitchell SR. |
First Address | Fort Scott, KS 66701-1317 |
Second Address | Fort Scott, KS 66701-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 13/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100090050A | (05) | KS |
188855 | COVENTRY HEALTHCARE (01) | KS |
23665019 | BCBS OF KANSAS CITY (01) | KS |
338790 | FAMILY HEALTH PARTNERS (01) | KS |
410014059 | MEDICARE RAILROAD (01) | KS |
5120 | BLUE CROSS BLUE SHIELD (01) | KS |
664300 | FIRST GUARD (01) | KS |
T74837 | (02) | KS |