Provider Demographics
NPI:1043203045
Name:MITCHELL, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24755 CHAGRIN BLVD
Mailing Address - Street 2:STE 345
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5692
Mailing Address - Country:US
Mailing Address - Phone:216-297-3230
Mailing Address - Fax:216-342-5290
Practice Address - Street 1:24755 CHAGRIN BLVD
Practice Address - Street 2:SUITE 345
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5692
Practice Address - Country:US
Practice Address - Phone:216-297-3230
Practice Address - Fax:216-342-5290
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-1755-M207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0315046Medicaid
DS4304OtherRAILROAD MEDICARE
DS4304OtherRAILROAD MEDICARE
H006731Medicare PIN
OH0808816Medicare PIN
OH0892361Medicare PIN
OH1193810001OtherDMERC MEDICARE
OH0808814Medicare ID - Type UnspecifiedMEDICARE #
OH0808819Medicare PIN
OH34-1844400OtherTAX ID#
OH0315046Medicaid
OH0808815Medicare PIN