MEDICARE: MICHIGAN EYE CLINIC PC

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	4901004300	MI

General Provider Information

NPI Number	:	1740578947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN EYE CLINIC PC

Provider Business Mailing Address
First Line	:	6706 KENNESAW RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1281
Country	:	US
Telephone Number	:	313-707-6667
Fax Number	:	734-667-3117

Provider Business Practice Location Address
First Line	:	6706 KENNESAW RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1281
Country	:	US
Telephone Number	:	313-707-6667
Fax Number	:	734-667-3117

Authorized Official
Title or Position	:	OWNER
Name	:	ALI H FAKIH
Credential	:	DO
Telephone Number	:	734-718-0411

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	06/02/2026

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