Individual
GLORIA STEPHANIE ENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1425 N LEROY ST, FENTON, MI 48430-2763
(810) 629-2041
(810) 629-9366
Mailing address
1425 N LEROY ST, FENTON, MI 48430-2763
(810) 629-2041
(810) 629-9366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004913
MI
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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