Healthcare Provider Details

I. General information

NPI: 1740578947
Provider Name (Legal Business Name): MICHIGAN EYE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6706 KENNESAW RD
CANTON MI
48187-1281
US

IV. Provider business mailing address

6706 KENNESAW RD
CANTON MI
48187-1281
US

V. Phone/Fax

Practice location:
  • Phone: 313-707-6667
  • Fax: 734-667-3117
Mailing address:
  • Phone: 313-707-6667
  • Fax: 734-667-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004300
License Number StateMI

VIII. Authorized Official

Name: ALI H FAKIH
Title or Position: OWNER
Credential: DO
Phone: 734-718-0411