MEDICARE: DR. WILLIAM ABRAHAM SHAHEEN III O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003733	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5287400001	OTHER		MEDICARE DME NO.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	900H202090	OTHER	MI	BLUE CROSS PROVIDER NO.

General Provider Information

NPI Number	:	1750596672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ABRAHAM SHAHEEN III O.D.

Provider Business Mailing Address
First Line	:	8598 LAKE RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1957
Country	:	US
Telephone Number	:	734-675-2079
Fax Number	:

Provider Business Practice Location Address
First Line	:	10531 W JEFFERSON AVE
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1306
Country	:	US
Telephone Number	:	313-841-5060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/22/2021

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