Organization
DR. BLAKE MITNICK, OPTOMETRIST, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE MITNICK O.D. (OPTOMETRIST)
(540) 745-8733
Entity
Organization
Contact information
Practice address
211 W MAIN ST, FLOYD, VA 24091-3190
(540) 745-8733
Mailing address
211 W MAIN ST, FLOYD, VA 24091-3190
(540) 745-8733
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000582
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013018423
—
VA
Enumeration date
09/26/2006
Last updated
11/05/2010
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