Dr. Blake Mitnick, Optometrist, PLC
Organization Active NPI Optometrist · Floyd, VA
NPI 1013018423 · NPPES record last updated Nov 5, 2010
Key facts
- NPI
- 1013018423
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 0618000582 (VA)
- Legal business name
- DR. BLAKE MITNICK, OPTOMETRIST, PLC
- Practice address
- 211 W Main St
Floyd, VA 24091-3190 - Phone
- (540) 745-8733
- NPI assigned
- Sep 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Blake Mitnick, O.D.
- Title
- Optometrist
- Phone
- (540) 745-8733
Practitioners 1
-
Blake Mitnick, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070509000326 | VA | Part B Supplier - Clinic/Group Practice | 5395841225 |
Receives reassigned benefits from 1 practitioner Practice locations: Floyd, VA |
National Provider Directory
Locations
211 W Main St
Floyd, VA 24091
Phone (540) 745-8733
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 0618000582 | VA | Yes |
Addresses
Primary practice location
211 W Main St
Floyd, VA 24091-3190
Mailing address
211 W Main St
Floyd, VA 24091-3190
Phone (540) 745-8733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013018423 | Medicaid | VA |
Other providers in Floyd, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.