Provider Demographics
NPI:1932249091
Name:BAHORSKI, LAURA J (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:BAHORSKI
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2424 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1010
Mailing Address - Country:US
Mailing Address - Phone:313-366-5100
Mailing Address - Fax:313-366-5104
Practice Address - Street 1:18193 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3219
Practice Address - Country:US
Practice Address - Phone:586-771-7720
Practice Address - Fax:586-771-7725
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU81459Medicare UPIN