Healthcare Provider Details

I. General information

NPI: 1639166895
Provider Name (Legal Business Name): OPTICAL FASHION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W BIG BEAVER RD E132
TROY MI
48084-3243
US

IV. Provider business mailing address

2801 W BIG BEAVER RD E132
TROY MI
48084-3243
US

V. Phone/Fax

Practice location:
  • Phone: 248-643-6220
  • Fax: 248-643-4914
Mailing address:
  • Phone: 248-643-6220
  • Fax: 248-643-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: HERMAN BENNETT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 248-643-6220