Healthcare Provider Details

I. General information

NPI: 1285457002
Provider Name (Legal Business Name): AMNA VAHIDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19173 MACK AVE
GROSSE POINTE WOODS MI
48236-2803
US

IV. Provider business mailing address

19173 MACK AVE
GROSSE POINTE WOODS MI
48236-2803
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-7883
  • Fax:
Mailing address:
  • Phone: 313-882-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005846
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: