1174261218 NPI number — ANDERSEN EYE PROSTHETICS LLC

Table of content: (NPI 1174261218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174261218 NPI number — ANDERSEN EYE PROSTHETICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSEN EYE PROSTHETICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174261218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5649
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603-0649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-341-7171
Provider Business Mailing Address Fax Number:
989-249-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 7 MILE RD STE 2400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-797-2400
Provider Business Practice Location Address Fax Number:
989-245-1035
Provider Enumeration Date:
05/26/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAZEN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
989-797-2400

Provider Taxonomy Codes

  • Taxonomy code: 156FX1700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)