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1194613794 NPI number — LATIFA BERRY OD

NPI Number: 1194613794
Health Care Provider/Practitioner: LATIFA BERRY OD

Information about “1194613794” NPI (LATIFA BERRY OD) exists in 1194613794 in HTML format HTML  |  1194613794 in plain Text format TXT  |  1194613794 in PDF (Portable Document Format) PDF  |  1194613794 in an XML format XML  formats.

NPI Number : 1194613794 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194613794",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERRY",
    "FirstName": "LATIFA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "30600 W. 12 MILE RD.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FARMINGTON HILLS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48334",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-737-3937",
    "MailingAddressFaxNumber": "248-737-2816",
    "FirstLinePracticeLocationAddress": "1769 WASHTENAW RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YPSILANTI",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48197-2020",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-483-2100",
    "PracticeLocationAddressFaxNumber": "734-483-2060",
    "EnumerationDate": "06/24/2025",
    "LastUpdateDate": "06/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "4901005895",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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