Shundale Thomas Mixon
Optometrist
1300 Peachtree Industrial Blvd Ste 1206
Suwanee
, Georgia 30024-4550
Shundale Thomas Mixon
Optometrist
1300 Peachtree Industrial Blvd Ste 1206
Suwanee
, Georgia 30024-4550
(636) 200-4393
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Shundale Thomas Mixon
- Po Box 207173
- Dallas, TX
- Zip : 75320-7173
- Phone : (636) 200-4393
Second Address
- Shundale Thomas Mixon
- 1300 Peachtree Industrial Blvd Ste 1206
- Suwanee, GA
- Zip : 30024-4550
- Phone : (334) 318-0713
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OPT003111 | GA |
National Provider Identifier
| NPI | 1013403088 |
|---|---|
| Provider Name | Shundale Thomas Mixon |
| First Address | Dallas, TX 75320-7173 |
| Second Address | Suwanee, GA 30024-4550 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/07/2018 |
| Last Update Date | 14/06/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.