Healthcare Provider Details

I. General information

NPI: 1255091716
Provider Name (Legal Business Name): CHILDREN'S EYE CARE OF NORTHERN COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2021
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD UNIT 350
FORT COLLINS CO
80528-3404
US

IV. Provider business mailing address

2121 E HARMONY RD UNIT 350
FORT COLLINS CO
80528-3404
US

V. Phone/Fax

Practice location:
  • Phone: 970-214-8175
  • Fax:
Mailing address:
  • Phone: 970-214-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN GRAEBER MITCHELL
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 315-559-2729