Healthcare Provider Details

I. General information

NPI: 1710822606
Provider Name (Legal Business Name): MARGARET ELIZABETH ROACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 FORD RD
CANTON MI
48187-4311
US

IV. Provider business mailing address

39500 FORD RD
CANTON MI
48187-4311
US

V. Phone/Fax

Practice location:
  • Phone: 734-983-0556
  • Fax: 734-983-0558
Mailing address:
  • Phone: 734-983-0556
  • Fax: 734-983-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: