Healthcare Provider Details

I. General information

NPI: 1114249141
Provider Name (Legal Business Name): MICHIGAN OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27118 GRATIOT AVE INSIDE COSTCO ROSEVILLE
ROSEVILLE MI
48066
US

IV. Provider business mailing address

50854 CALVERT ISLE DR
NOVI MI
48374-2559
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-2224
  • Fax: 855-852-5529
Mailing address:
  • Phone: 914-522-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL BAJAJ
Title or Position: PRESIDENT
Credential: OD
Phone: 248-747-4496