Organization
MARK C MITCHUM OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK CHANDLER MITCHUM OD (PRESIDENT)
(919) 775-5221
Entity
Organization
Contact information
Practice address
2648 LEE AVENUE, SANFORD, NC 27332-5950
(919) 775-5221
(919) 775-7655
Mailing address
2648 LEE AVENUE, SANFORD, NC 27332-5950
(919) 775-5221
(919) 775-7655
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1270
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093N1
BCBSNC
NC
05
—
89093N1
—
NC
Enumeration date
06/09/2006
Last updated
03/12/2008
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