Provider Demographics
NPI:1639166895
Name:OPTICAL FASHION, INC.
Entity Type:Organization
Organization Name:OPTICAL FASHION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-643-6220
Mailing Address - Street 1:2801 W BIG BEAVER RD
Mailing Address - Street 2:E132
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3243
Mailing Address - Country:US
Mailing Address - Phone:248-643-6220
Mailing Address - Fax:248-643-4914
Practice Address - Street 1:2801 W BIG BEAVER RD
Practice Address - Street 2:E132
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3243
Practice Address - Country:US
Practice Address - Phone:248-643-6220
Practice Address - Fax:248-643-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty