MEDICARE: DR. MICHELLE MITCHELL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3071	CT

General Provider Information

NPI Number	:	1235622564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MITCHELL OD

Provider Business Mailing Address
First Line	:	121 LA PORTE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4379
Country	:	US
Telephone Number	:	970-682-2627
Fax Number	:	970-682-1835

Provider Business Practice Location Address
First Line	:	121 LA PORTE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4379
Country	:	US
Telephone Number	:	970-682-2627
Fax Number	:	970-682-1835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	12/12/2025

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