Individual
DR. MICHELLE MARIE GO MIJARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2018043160
MO
152W00000X
Optometrist
TUV008133-1
NY
Other
Enumeration date
06/23/2014
Last updated
11/01/2019
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