Provider Demographics
NPI:1194613794
Name:BERRY, LATIFA (OD)
Entity type:Individual
Prefix:DR
First Name:LATIFA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30600 W. 12 MILE RD.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-737-3937
Mailing Address - Fax:248-737-2816
Practice Address - Street 1:1769 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2020
Practice Address - Country:US
Practice Address - Phone:734-483-2100
Practice Address - Fax:734-483-2060
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist