Mitchell, Mark Glenn
Mitchell, Mark Glenn is an sole proprietor health care provider with primary practice located at 678 E Santa Clara St , San Jose CA 95112-1931. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Mitchell, Mark Glenn can be contacted via phone (408) 293-2020.Contact Information
Primary practice address
678 E Santa Clara St
San Jose CA 95112-1931
Phone: (408) 293-2020
Fax: (408) 271-0225
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 8285T | California |
Profile Details
| NPI number | 1134124308 |
|---|---|
| LBN Legal business name | Mitchell, Mark Glenn |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 15th, 2005 |
| Last updated | Oct 27th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134124308 | NPPES |
| California | MEDICAID | SD0082850 | |
| California | Other | P00122561 |
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