Provider Demographics
NPI:1568190718
Name:BASHIR TARRAF, OD, PC
Entity Type:Organization
Organization Name:BASHIR TARRAF, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:313-982-2425
Mailing Address - Street 1:15120 MICHIGAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3768
Mailing Address - Country:US
Mailing Address - Phone:313-982-2425
Mailing Address - Fax:
Practice Address - Street 1:15120 MICHIGAN AVE STE D
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3768
Practice Address - Country:US
Practice Address - Phone:313-982-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty