Individual provider Active NPI

David Mitchell, O.D.

  • Optometrist
  • Thibodaux, LA
National Provider Identifier
1912908658
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1411-553T Issued in LA
Practice address
425 Saint Mary St
Thibodaux, LA 70301-2641
Phone
(985) 447-2393
NPI assigned
Aug 3, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1411-553T LA Primary
Pediatric Optometrist 152WP0200X 1411-553T LA
Vision Therapy Optometrist 152WV0400X 1411-553T LA
Corneal and Contact Management Optometrist 152WC0802X 1411-553T LA
Low Vision Rehabilitation Optometrist 152WL0500X 1411-553T LA

Addresses

Primary practice location

425 Saint Mary St
Thibodaux, LA 70301-2641

Mailing address

425 Saint Mary St
Thibodaux, LA 70301-2641
Phone (985) 447-2393

Other identifiers 1

IdentifierTypeStateIssuer
1507032MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060817000123 LA Practitioner - Optometry 5991776486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mitchell Eye Care Associates, L.L.C.Group PAC ID 3173526183, 3 clinicians

Practice addresses (Care Compare)

425 Saint Mary St
Thibodaux, LA 70301-2641
Phone (985) 447-2393

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1411-553TLAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Vision Center Pediatrics Current Accepting new patients
Mitchell Eye Care Associates, L.L.C. Optometrist CurrentSince Jun 14, 2006 Accepting new patients

Locations

425 Saint Mary St
Thibodaux, LA 70301
Phone (985) 228-1233

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1912908658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 SAINT MARY ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703012641",
            "telephone_number": "985-447-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 SAINT MARY ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703012641",
            "telephone_number": "985-447-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1411-553T",
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "LA",
            "license": "1411-553T",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "LA",
            "license": "1411-553T",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "LA",
            "license": "1411-553T",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "LA",
            "license": "1411-553T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1507032",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

Verify at the official NPI Registry.