Provider Demographics
NPI:1962705491
Name:MOBILE EYE CARE, LLC
Entity type:Organization
Organization Name:MOBILE EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:313-278-7336
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48123-2044
Mailing Address - Country:US
Mailing Address - Phone:313-278-7336
Mailing Address - Fax:
Practice Address - Street 1:22137 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2204
Practice Address - Country:US
Practice Address - Phone:313-278-7336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty