| Heritage Optical Center Inc | |
|
19010 Livernois Ave, Detroit, MI 48221-2259 | |
| (313) 863-9581 | |
| (313) 863-7710 |
| Full Name | Heritage Optical Center Inc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 19010 Livernois Ave, Detroit, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285728964 | NPI | - | NPPES |
| 2831091 | Medicaid | MI | |
| 4971556 | Medicaid | MI | |
| 5102658 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 4601003146 (Michigan) | Primary |
| Provider Name | Lanny Green |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1972557858 PECOS PAC ID: 3072588193 Enrollment ID: I20060110000662 |
| Provider Name | Rovetta Mattia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1366497661 PECOS PAC ID: 7416969555 Enrollment ID: I20060608000113 |
| Provider Name | Bradley Habermehl |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356375463 PECOS PAC ID: 2365443314 Enrollment ID: I20070118000342 |
| Provider Name | Dawn Kathleen Caldwell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1649311697 PECOS PAC ID: 0941308522 Enrollment ID: I20070605000418 |
| Provider Name | Laura J Bahorski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932249091 PECOS PAC ID: 7911007315 Enrollment ID: I20070714000060 |
| Provider Name | Robert T Kocembo |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730118878 PECOS PAC ID: 7214024009 Enrollment ID: I20071025000417 |
| Provider Name | Robert E Deck |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1437177342 PECOS PAC ID: 0648386862 Enrollment ID: I20130606000550 |
| Provider Name | Jennifer N Dudovitz |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790720225 PECOS PAC ID: 3870864929 Enrollment ID: I20170808000752 |
| Provider Name | Fatima Karim |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1538545611 PECOS PAC ID: 1850641333 Enrollment ID: I20180904001812 |
| Provider Name | Katherine Anderson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1124500699 PECOS PAC ID: 1951733070 Enrollment ID: I20191112000458 |
| Provider Name | Alexandra D Heisler |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1922411651 PECOS PAC ID: 1850698374 Enrollment ID: I20200813000522 |
| Provider Name | Chisom O Chukwumerije |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275114837 PECOS PAC ID: 8426448358 Enrollment ID: I20220613001869 |
| Provider Name | Tiffany Marcoe |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1083182950 PECOS PAC ID: 8921347303 Enrollment ID: I20220920000640 |
| Provider Name | Iqjyot K Gill |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1851053003 PECOS PAC ID: 0749657708 Enrollment ID: I20221103001367 |
| Provider Name | Wassim H Fakih |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1396443206 PECOS PAC ID: 4082070248 Enrollment ID: I20230515002329 |
| Provider Name | Al'tiana Manning |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1821615873 PECOS PAC ID: 5092103408 Enrollment ID: I20231019002984 |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Optical Center Inc 19010 Livernois Ave, Detroit, MI 48221-2259 Ph: (313) 863-9581 | Heritage Optical Center Inc 19010 Livernois Ave, Detroit, MI 48221-2259 Ph: (313) 863-9581 |
Dr. Robert Fredrick Lee Iii, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 15157 Gratiot Ave, Detroit, MI 48205 Phone: 313-526-7664 Fax: 313-526-2055 | |
Dr. Sura Hassan, OD Optometrist Medicare: Medicare Enrolled Practice Location: 4717 St. Antoine, Kresge Eye Institute, Detroit, MI 48201 Phone: 313-577-8900 Fax: 313-577-0700 | |
Dr. Richard Edwin Gay, OD Optometrist Medicare: Medicare Enrolled Practice Location: 19173 Mack Ave, Detroit, MI 48230 Phone: 313-882-7883 Fax: 313-882-5128 | |
Heritage Optical Inc. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2678 E Jefferson Ave, Detroit, MI 48207 Phone: 313-259-6006 | |
Dr. Linda Le, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1301 Orleans St Apt 1705, Detroit, MI 48207 Phone: 248-759-9202 | |
Wayne State University Physician Group Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4717 Saint Antoine St, Detroit, MI 48201 Phone: 313-577-8900 Fax: 313-577-0700 | |
Heritage Optical Center, Inc. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 19010 Livernois Ave, Detroit, MI 48221 Phone: 313-863-9581 |