Individual
DR. MATTHEW DAVID MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
105 W HARVEST RD, BLUFFTON, IN 46714-9007
(260) 824-3424
Mailing address
PO BOX 374, BLUFFTON, IN 46714-0374
(260) 824-3424
(260) 824-9116
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003000A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000528552
BCBS
IN
01
—
18003000
LICENSE#
IN
Enumeration date
08/13/2006
Last updated
11/30/2007
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