Provider Demographics
NPI:1831257443
Name:MITCHELL, ROBERT B (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:760 PUSCH VIEW LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9378
Mailing Address - Country:US
Mailing Address - Phone:520-229-2010
Mailing Address - Fax:520-229-2111
Practice Address - Street 1:760 PUSCH VIEW LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9378
Practice Address - Country:US
Practice Address - Phone:520-229-2010
Practice Address - Fax:520-229-2111
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z154612OtherPTAN
Z154612OtherPTAN
AZZ112205Medicare PIN