Individual provider Active NPI

Alexa Marie Ayyash, OD

  • Optometrist
  • South Lyon, MI
National Provider Identifier
1710728258
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005797 Issued in MI
Practice address
22371 Pontiac TRL
South Lyon, MI 48178-1658
Phone
(248) 437-7600
NPI assigned
Jun 6, 2024
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901005797 MI Primary

Addresses

Primary practice location

22371 Pontiac TRL
South Lyon, MI 48178-1658

Mailing address

21020 Taft Rd
Northville, MI 48167-1004
Phone (248) 595-2701

Other practice location 1

42400 Ford Rd
Canton, MI 48187-3337
Phone (734) 981-9276

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240805000687 MI Practitioner - Optometry 2567909823 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4901005797MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Plus Inc. Optometrist CurrentSince Aug 10, 2025 Accepting new patients
Visionworks, Inc Optometrist CurrentSince Aug 5, 2024 Accepting new patients
Clarity Vision Plus, PLLC Optometrist CurrentSince Aug 10, 2025 Accepting new patients
Visionworks, Inc CurrentSince Aug 5, 2024 Accepting new patients
Visionworks, Inc. Optometrist PastSince Jun 1, 2024 Accepting new patients

Locations

42400 Ford Rd
Canton, MI 48187
Phone (586) 566-6341

3620 28th St SE
Kentwood, MI 49512
Phone (616) 512-0323

22371 Pontiac Trl
South Lyon, MI 48178
Phone (248) 437-3351

23360 Eureka Rd
Taylor, MI 48180
Phone (734) 287-0024

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1710728258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21020 TAFT RD",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481671004",
            "telephone_number": "248-595-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22371 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781658",
            "telephone_number": "248-437-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42400 Ford Rd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481873337",
            "country_code": "US",
            "telephone_number": "734-981-9276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AYYASH",
        "first_name": "ALEXA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lyon, MI

Sources for this page

Verify at the official NPI Registry.