Provider Demographics
NPI:1598151318
Name:MICHIGAN EYE CARE PROVIDER PLLC
Entity Type:Organization
Organization Name:MICHIGAN EYE CARE PROVIDER PLLC
Other - Org Name:FRASER EYE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-296-7250
Mailing Address - Street 1:33080 UTICA RD STE B
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2038
Mailing Address - Country:US
Mailing Address - Phone:586-296-7250
Mailing Address - Fax:586-296-7256
Practice Address - Street 1:33080 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2038
Practice Address - Country:US
Practice Address - Phone:586-296-7250
Practice Address - Fax:586-296-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty