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General NPI Number Information
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NPI Number | 1124462452
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Entity Type | Organization
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Legal Business Name | DRY EYE HEALING INSTITUTE
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 5600 W MAPLE RD STE A120
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3782
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Country | US
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Telephone | 248-413-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 W MAPLE RD STE A120
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3782
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Country | US
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Telephone | 248-847-3372
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Fax | 248-243-8963
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Authorized Official
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Title or Position | DOCTOR
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Name | JENNIFER JANE SHABA
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Credential | OD
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Telephone | 248-847-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004524
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License Number State | MI
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