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General NPI Number Information
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NPI Number | 1194613794
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Entity Type | Individual
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Provider Name | LATIFA BERRY OD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1769 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-2020
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Country | US
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Telephone | 734-483-2100
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Fax | 734-483-2060
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Provider Business Mailing Address
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Address Line | 30600 W. 12 MILE RD.
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334
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Country | US
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Telephone | 248-737-3937
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Fax | 248-737-2816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901005895
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License Number State | MI
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