Healthcare Provider Details

I. General information

NPI: 1194613968
Provider Name (Legal Business Name): MICHELLE LUCY PERALES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 371 JUNCTION ROUTE 9
CROWNPOINT NM
87313
US

IV. Provider business mailing address

HWY 371 JUNCTION ROUTE 9
CROWNPOINT NM
87313
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36056
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2026-0007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: