Healthcare Provider Details

I. General information

NPI: 1245528363
Provider Name (Legal Business Name): MELISSA BUSSEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 S PLAZA DR
TAYLOR MI
48180-5202
US

IV. Provider business mailing address

4717 SAINT ANTOINE ST
DETROIT MI
48201-1423
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-2666
  • Fax: 734-287-3864
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: