Healthcare Provider Details

I. General information

NPI: 1417873092
Provider Name (Legal Business Name): MICHAEL JEFFREY GIRARDIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3788 S 16TH AVE
TUCSON AZ
85713-6079
US

IV. Provider business mailing address

955 W SOUTHERN AVE STE 101
MESA AZ
85210-4903
US

V. Phone/Fax

Practice location:
  • Phone: 520-388-9741
  • Fax: 520-388-9750
Mailing address:
  • Phone: 480-961-1865
  • Fax: 480-893-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: