1659418531 NPI number — ROY H. MITTMANN, O.D. AND ASSOCIATES INC.

Table of content: (NPI 1659418531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659418531 NPI number — ROY H. MITTMANN, O.D. AND ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY H. MITTMANN, O.D. AND ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659418531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72756
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-8019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-378-8784
Provider Business Mailing Address Fax Number:
804-423-5790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 MIDLOTHIAN TPKE
Provider Second Line Business Practice Location Address:
SUITE 672
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-4771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-378-8784
Provider Business Practice Location Address Fax Number:
804-423-5790
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MITTMANN
Authorized Official First Name:
ROY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR / PRESIDENT
Authorized Official Telephone Number:
804-378-8784

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000405 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OP2564 . This is a "EYEMED GROUP ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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