Provider Demographics
NPI:1851932693
Name:TOKATLY, YOUSIF (OD)
Entity Type:Individual
Prefix:
First Name:YOUSIF
Middle Name:
Last Name:TOKATLY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30320 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1608
Mailing Address - Country:US
Mailing Address - Phone:248-978-8653
Mailing Address - Fax:
Practice Address - Street 1:6667 ORCHARD LAKE RD STE B200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3404
Practice Address - Country:US
Practice Address - Phone:248-862-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist