Active NPI
Michelle Marie Go Mijares, O.D.
- Optometrist
- Saint Louis, MO
National Provider Identifier
1861807380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2018043160
- Practice address
- 4901 Forest Park Ave
Saint Louis, MO 63108-1495 - Phone
- (314) 362-3937
- Fax
- (866) 505-8818
- NPI assigned
- Jun 23, 2014
- Last updated
- Oct 20, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2018043160 | MO | Primary |
| Optometrist | 152W00000X | TUV008133-1 | NY |
Addresses
Primary practice location
4901 Forest Park Ave
Saint Louis, MO 63108-1495
Mailing address
PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-3937
Other practice location 1
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Phone (928) 729-8000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Washington University |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV008133-1 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pueblo Pintado Clinic | Current | Accepting new patients | |
| DHHS PHS Naihs Crownpoint Hospital | Current | Accepting new patients | |
| Thoreau Clinic | Current | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Thoreau, NM
- NPI 1679516702
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1792454400000",
"number": "1861807380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7412011",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606742011",
"telephone_number": "314-362-3937",
"fax_number": "866-505-8818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 FOREST PARK AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631081495",
"telephone_number": "314-362-3937",
"fax_number": "866-505-8818"
}
],
"practiceLocations": [
{
"address_1": "Corner of Route N12 and N7",
"address_purpose": "LOCATION",
"city": "Fort Defiance",
"state": "AZ",
"postal_code": "86504",
"country_code": "US",
"telephone_number": "928-729-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIJARES",
"first_name": "MICHELLE MARIE",
"middle_name": "GO",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-23",
"last_updated": "2026-10-20",
"certification_date": "2026-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "2018043160",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV008133-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "Y",
"affiliationName": "Washington University",
"address_1": "4901 Forest Park Ave",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631081495",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.