Provider Demographics
NPI:1265589576
Name:HALWAJI, LINA (OD)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:HALWAJI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4591
Mailing Address - Country:US
Mailing Address - Phone:248-396-3968
Mailing Address - Fax:
Practice Address - Street 1:334 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4542
Practice Address - Country:US
Practice Address - Phone:248-585-5830
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
MI4901003875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930009Medicare ID - Type Unspecified
MIU69200Medicare UPIN