1720115108 NPI number — DR. ROMEA EVANTY MITCHELL O.D.

Table of content: DR. ROMEA EVANTY MITCHELL O.D. (NPI 1720115108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720115108 NPI number — DR. ROMEA EVANTY MITCHELL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
ROMEA
Provider Middle Name:
EVANTY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRISBAXTER
Provider Other First Name:
ROMEA
Provider Other Middle Name:
EVANTY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720115108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 421719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77242-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-775-0428
Provider Business Mailing Address Fax Number:
281-469-7114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11115 MCCRACKEN LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-4487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-469-7610
Provider Business Practice Location Address Fax Number:
281-469-7114
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7002T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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