MEDICARE: MANIJEH SHAFIEMIR OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003851	MI

General Provider Information

NPI Number	:	1225020043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANIJEH SHAFIEMIR OD

Provider Business Mailing Address
First Line	:	24169 WESTMONT CT
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48374-3656
Country	:	US
Telephone Number	:	248-380-8178
Fax Number	:

Provider Business Practice Location Address
First Line	:	13530 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3574
Country	:	US
Telephone Number	:	313-827-0779
Fax Number	:	313-827-0784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/04/2016

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