Provider Demographics
NPI:1689900292
Name:MIJANGOS OPTOMETRY INC.
Entity Type:Organization
Organization Name:MIJANGOS OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:MIJANGOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-422-1745
Mailing Address - Street 1:428 BISON TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5295
Mailing Address - Country:US
Mailing Address - Phone:605-422-1745
Mailing Address - Fax:
Practice Address - Street 1:3400 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5162
Practice Address - Country:US
Practice Address - Phone:712-252-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty