Provider Demographics
NPI:1053147769
Name:EVANS, MITCHELL N (OD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:N
Last Name:EVANS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4370
Mailing Address - Country:US
Mailing Address - Phone:336-687-7730
Mailing Address - Fax:336-434-6680
Practice Address - Street 1:10564 N MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2483
Practice Address - Country:US
Practice Address - Phone:336-434-4033
Practice Address - Fax:336-434-4035
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist