Healthcare Provider Details

I. General information

NPI: 1902758899
Provider Name (Legal Business Name): GRACE J WEAKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51450 SHELBY PKWY
SHELBY TOWNSHIP MI
48315-1786
US

IV. Provider business mailing address

11571 BEACONSFIELD RD
WASHINGTON MI
48094-3006
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-0658
  • Fax: 586-997-3567
Mailing address:
  • Phone: 586-651-1310
  • Fax: 586-997-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: