Provider Demographics
NPI:1164092490
Name:SASHA SHAMMAMI, OD, PLLC
Entity Type:Organization
Organization Name:SASHA SHAMMAMI, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-497-8636
Mailing Address - Street 1:4679 FORESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4547
Mailing Address - Country:US
Mailing Address - Phone:248-497-8636
Mailing Address - Fax:
Practice Address - Street 1:1301 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7017
Practice Address - Country:US
Practice Address - Phone:248-643-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUXOTTICA RETAIL NORTH AMERICA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty