Healthcare Provider Details

I. General information

NPI: 1013428648
Provider Name (Legal Business Name): RYAN CHAHINE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S TELEGRAPH RD STE 100
BLOOMFIELD HILLS MI
48302-0951
US

IV. Provider business mailing address

2550 S TELEGRAPH RD STE 100
BLOOMFIELD HILLS MI
48302-0951
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-9000
  • Fax:
Mailing address:
  • Phone: 248-258-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: