Individual
DR. LISA L MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
425 SAINT MARY ST, THIBODAUX, LA 70301-2641
(985) 447-2393
Mailing address
425 SAINT MARY ST, THIBODAUX, LA 70301-2641
(985) 447-2393
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001392
VA
152W00000X
Optometrist
Primary
1412-554T
LA
152W00000X
Optometrist
1960
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010421
—
LA
01
—
4K179C398
MEDICARE-UNSPECIFIED
—
Enumeration date
08/03/2005
Last updated
12/02/2016
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