Jeffrey A Mitchell, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

2018 Issued in OK

Practice address

1108 W Cherokee St
Wagoner, OK 74467-4622

Phone

(918) 485-2123

NPI assigned

Aug 19, 2006

Last updated

Sep 14, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Wagoner Eye Clinic Inc

  • Optometrist
  • Wagoner, OK
  • NPI 1497826358
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1750495206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744770158",
            "telephone_number": "918-485-2123",
            "fax_number": "918-485-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674622",
            "telephone_number": "918-485-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OK",
            "license": "2018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100759760A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelli Leeann McNally
• Mary Susan McVay
• Madison M Medlock
• Hailey Nicole Miller
• Natasha Rose Milligan
• Jennifer Mitchell, MSW
• Kathy Sue Mobus
• Monduta Healthcare Services LLC (Dunamis Complete Health)
• Amanda Leeann Moore, GED
• Toni Rae Moore, C.B.D.

• Corneal and Contact Management Optometrist in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Corneal and Contact Management Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.