Provider Demographics
NPI:1952458259
Name:HABIB, SABIHA FATIMA (OD)
Entity Type:Individual
Prefix:
First Name:SABIHA
Middle Name:FATIMA
Last Name:HABIB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SABIHA
Other - Middle Name:
Other - Last Name:ANSARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5150 BANTRY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1532
Mailing Address - Country:US
Mailing Address - Phone:734-542-0201
Mailing Address - Fax:734-542-0209
Practice Address - Street 1:2800 W BIG BEAVER RD
Practice Address - Street 2:STE V368
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3206
Practice Address - Country:US
Practice Address - Phone:248-816-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV07357Medicare UPIN
MIN26930023Medicare ID - Type Unspecified