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General NPI Number Information
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NPI Number | 1962705491
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Entity Type | Organization
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Legal Business Name | MOBILE EYE CARE, LLC
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 22137 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-2204
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Country | US
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Telephone | 313-278-7336
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2044
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City | DEARBORN
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State | MI
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Zip | 48123-2044
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Country | US
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Telephone | 313-278-7336
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BASEEM WAHAB
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Credential | OD
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Telephone | 313-278-7336
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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 | 4901004506
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License Number State | MI
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