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General NPI Number Information
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NPI Number | 1598151318
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Entity Type | Organization
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Legal Business Name | MICHIGAN EYE CARE PROVIDER PLLC
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 33080 UTICA RD
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City | FRASER
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State | MI
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Zip | 48026-2038
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Country | US
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Telephone | 586-296-7250
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Fax | 586-296-7256
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Provider Business Mailing Address
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Address Line | 33080 UTICA RD STE B
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City | FRASER
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State | MI
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Zip | 48026-2038
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Country | US
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Telephone | 586-296-7250
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Fax | 586-296-7256
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAHDI M BASHA
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Credential | DO
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Telephone | 586-296-7250
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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