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Mr. Edward Mitchell JR., LDO
Eyewear Supplier in Crestview, Florida
NPI 1811139462

Edward Mitchell JR. is a Eyewear Supplier based in Crestview, FL. Edward Mitchell JR. practices in Crestview, FL and has the professional credentials of LDO. The NPI Number for Edward Mitchell JR. is 1811139462 and holds a License No. DO 5539 (Florida).

The current practice location address for Edward Mitchell JR. is 4100 S Ferdon Blvd Ste B5, Crestview, FL and can be reached out via phone at 850-758-0474 and via fax at 850-682-0057.

Location: 4100 S Ferdon Blvd Ste B5, Crestview, FL, 32536-5287
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1811139462
Provider Name
Edward Mitchell JR.
Credential
LDO
Provider Entity Type
Individual
Gender
Male
Address
4100 S Ferdon Blvd Ste B5, Crestview, FL, 32536-5287
Phone Number
850-758-0474
Fax Number
850-682-0057
Provider Enumeration Date
03/28/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
80-0442282 01 IRS
institution
Provider Business Practice Location Address Details
Address
4100 S Ferdon Blvd Ste B5
City
Crestview
State
Florida
Zip
32536-5287
Phone Number
850-758-0474
Fax Number
850-682-0057
person
Provider Business Mailing Address Details
Address
4100 S Ferdon Blvd Ste B5
City
Crestview
State
Florida
Zip
32536-5287
Phone Number
850-758-0474
Fax Number
850-682-0057
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Contact Lens Fitter
Taxonomy
156FC0801X
License No.
5539 (Florida)
Definition
An optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact lenses to a patient based on the prescription of an optometrist or medical physician.
person
Provider's Taxonomy Details 2
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
156FX1800X
License No.
DO 5539 (Florida)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Eyewear Supplier
Speciality
-
Taxonomy
332H00000X
License No.
DO 5539 (Florida)
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
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