Provider Demographics
NPI:1871529479
Name:PURVIS, MITCHELL V (O,D)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:V
Last Name:PURVIS
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
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Mailing Address - Street 1:961 ALABAMA HIGHWAY 203
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-4228
Mailing Address - Country:US
Mailing Address - Phone:334-897-2142
Mailing Address - Fax:334-897-3632
Practice Address - Street 1:961 ALABAMA HIGHWAY 203
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-4228
Practice Address - Country:US
Practice Address - Phone:334-897-2142
Practice Address - Fax:334-897-3632
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69035Medicare UPIN