Mitchell Eye Center, PLLC
Organization Active NPI Clinic/Center · Selmer, TN
NPI 1235633199 · NPPES record last updated Mar 23, 2018
Key facts
- NPI
- 1235633199
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- MITCHELL EYE CENTER, PLLC
- Practice address
- 699 E Poplar Ave
Selmer, TN 38375-1828 - Phone
- (731) 610-7317
- NPI assigned
- Mar 23, 2018
- Organization subpart
- No
Authorized official
- Name
- Andrea Jo Mitchell, OD
- Title
- Optometrist
- Phone
- (731) 610-7317
Practitioners 18
-
Andrea Jo Mitchell, O.D.
-
Kyley Mitchell, OD
-
Paul A Avenel, MD
-
James Daniel Baxter, M.D.
-
Heather R Dolan, A.P.R.N.
-
Dennis William Merski, D.O.
-
Donna Renai Norris, APRN, BC
-
Eric Robinson, MD
-
Gary David Strasberg, M.D.
-
James M. Clark, M.D.
-
Diane Klivington, DO, MS
-
Shimshon Porat, MD
-
Crystal Rose Wilson, CFNP
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Mitchell Eye Center, PLLC |
Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Prosthetic Lenses: Conventional Eyeglasses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180629000463 | TN | Part B Supplier - Clinic/Group Practice | 2961758222 |
Receives reassigned benefits from 3 practitioners Practice locations: Selmer, TN |
| O20180806003176 | TN | DME Supplier - Physician - Optometrist | 2961758222 | Practice locations: Selmer, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
699 E Poplar Ave
Selmer, TN 38375-1828
Mailing address
PO Box 833
Selmer, TN 38375-0833
Phone (731) 610-7317
NPI Registry JSON
{
"created_epoch": "1521763200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1521763200000",
"number": "1235633199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 833",
"city": "SELMER",
"state": "TN",
"postal_code": "383750833",
"telephone_number": "731-610-7317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "699 E POPLAR AVE",
"city": "SELMER",
"state": "TN",
"postal_code": "383751828",
"telephone_number": "731-610-7317"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MITCHELL EYE CENTER, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-03-23",
"last_updated": "2018-03-23",
"status": "A",
"authorized_official_last_name": "MITCHELL",
"authorized_official_first_name": "ANDREA",
"authorized_official_middle_name": "JO",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "731-610-7317",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Selmer, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2018. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.