Healthcare Provider Details

I. General information

NPI: 1720995442
Provider Name (Legal Business Name): STEPHANIE HEIRMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 N ADAMS RD SPC C-142
ROCHESTER HILLS MI
48309-1376
US

IV. Provider business mailing address

142 N ADAMS RD SPC C-142
ROCHESTER HILLS MI
48309-1376
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-8154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005997
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: