Healthcare Provider Details

I. General information

NPI: 1255258000
Provider Name (Legal Business Name): ALEX BAHRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

30660 W 12 MILE RD
FARMINGTON HILLS MI
48334-3808
US

IV. Provider business mailing address

4507 TWIN BEACH CT
WEST BLOOMFIELD MI
48323-2973
US

V. Phone/Fax

Practice location:
  • Phone: 248-737-3937
  • Fax: 248-737-2816
Mailing address:
  • Phone: 248-756-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: