Active NPI
Mark Chandler Mitchum, OD
- Optometrist
- Sanford, NC
National Provider Identifier
1326087461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1270
- Practice address
- 2648 Lee Avenue
Sanford, NC 27332-5950 - Phone
- (919) 775-5221
- Fax
- (919) 775-7655
- NPI assigned
- Jun 5, 2006
- Last updated
- Sep 24, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1270 | NC | Primary |
Addresses
Primary practice location
2648 Lee Avenue
Sanford, NC 27332-5950
Mailing address
428 Chandler Grant Dr
Cary, NC 27519-8838
Phone (336) 524-6604
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89093N1 | Medicaid | NC | |
| 093N1 | Other | NC | BCBSNC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 802 | SC | MD | School Psychologist |
| 1270 | NC | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc | Past | Accepting new patients | |
| The Eye Center, Doctors of Optometry, P.a. | Optometrist | Past | Accepting new patients |
| Modern Optical, Inc | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Sanford, NC
- NPI 1174564538
-
- Optician
- Sanford, NC
- NPI 1073642054
-
- Optometrist
- Durham, NC
- NPI 1174564900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569283200000",
"number": "1326087461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "428 CHANDLER GRANT DR",
"city": "CARY",
"state": "NC",
"postal_code": "275198838",
"telephone_number": "336-524-6604",
"fax_number": "336-524-6579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2648 LEE AVENUE",
"city": "SANFORD",
"state": "NC",
"postal_code": "273325950",
"telephone_number": "919-775-5221",
"fax_number": "919-775-7655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHUM",
"first_name": "MARK",
"middle_name": "CHANDLER",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2019-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1270",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89093N1",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC",
"identifier": "093N1",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sanford, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.