Provider Demographics
NPI:1396443206
Name:FAKIH, WASSIM H (OD)
Entity type:Individual
Prefix:
First Name:WASSIM
Middle Name:H
Last Name:FAKIH
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 1:50877 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2885
Mailing Address - Country:US
Mailing Address - Phone:248-880-4947
Mailing Address - Fax:
Practice Address - Street 1:50877 ROCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2885
Practice Address - Country:US
Practice Address - Phone:248-880-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5307011686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty