Provider Demographics
NPI:1457306425
Name:KHALIGHI - HICKINSON, FARIBA (OD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:KHALIGHI - HICKINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1516
Mailing Address - Country:US
Mailing Address - Phone:248-684-1229
Mailing Address - Fax:248-684-2306
Practice Address - Street 1:655 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1844
Practice Address - Country:US
Practice Address - Phone:248-577-3659
Practice Address - Fax:248-588-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFK003680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU54828Medicare UPIN