# CHILDREN'S OPTICAL OF NORTHERN COLORADO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Children's Optical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295435881
- **Authorized official:** MICHAEL MITCHELL (MANAGER)
- **Authorized official phone:** (970) 214-8175

## Contact information

- **Practice address:** 2121 E HARMONY RD UNIT 350A, FORT COLLINS, CO 80528-3404
- **Practice address phone:** (970) 214-8175
- **Practice address fax:** (970) 788-7376
- **Mailing address:** 2121 E HARMONY RD UNIT 350A, FORT COLLINS, CO 80528-3404
- **Mailing address phone:** (970) 214-8175
- **Mailing address fax:** (970) 788-7376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207WX0110X | Pediatric Ophthalmology and Strabismus Specialist Physician | — | NULL | Yes |
| 207WX0110X | Pediatric Ophthalmology and Strabismus Specialist Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2023
- **Last updated:** 03/03/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1053572438 | — | CO |
| 05 | — | 1255091716 | — | CO |