Provider Demographics
NPI:1255384996
Name:DOBRZELEWSKI, MITCHELL ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ROBERT
Last Name:DOBRZELEWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12900 S US 27
Mailing Address - Street 2:#7 DEWITT OPTOMETRY PC
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8340
Mailing Address - Country:US
Mailing Address - Phone:517-669-4411
Mailing Address - Fax:517-669-4433
Practice Address - Street 1:12900 S US-27
Practice Address - Street 2:#7 DEWITT OPTOMETRY PC
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820
Practice Address - Country:US
Practice Address - Phone:517-669-4411
Practice Address - Fax:517-669-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U50780Medicare UPIN
MI1272120001Medicare NSC
ON66730001Medicare ID - Type Unspecified