Edward Mitchell Jr., LDO

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

DO5539 Issued in FL

Practice address

4100 S Ferdon Blvd Ste B5
Crestview, FL 32536-5287

Phone

(850) 758-0474

Fax

(850) 682-0057

NPI assigned

Mar 28, 2009

Last updated

Oct 15, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Cabana Eyes Optical

  • Eyewear Supplier
  • Crestview, FL
  • NPI 1154867554
  NPD Authorized official

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

{
    "created_epoch": "1238198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1811139462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 S FERDON BLVD STE B5",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365287",
            "telephone_number": "850-758-0474",
            "fax_number": "850-682-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 S FERDON BLVD STE B5",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365287",
            "telephone_number": "850-758-0474",
            "fax_number": "850-682-0057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4724 Whitewater Ln",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395725",
            "country_code": "US",
            "telephone_number": "850-826-0698",
            "fax_number": "850-423-0142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-28",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "DO5539",
            "primary": true
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": "FL",
            "license": "DO 5539",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO 5539",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "5539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "80-0442282",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amanda Lizette Monroy, ARNP

• Eyewear Supplier in Crestview, FL
• Providers in Crestview, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.

Verify at the official NPI Registry.