Provider Demographics
NPI:1619616174
Name:DIRECT OPTICAL OF WEST BLOOMFIELD LLC
Entity Type:Organization
Organization Name:DIRECT OPTICAL OF WEST BLOOMFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHAJLOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-981-1760
Mailing Address - Street 1:6315 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5031
Mailing Address - Country:US
Mailing Address - Phone:248-231-3017
Mailing Address - Fax:734-981-1574
Practice Address - Street 1:6315 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-5031
Practice Address - Country:US
Practice Address - Phone:248-231-3017
Practice Address - Fax:734-981-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty