MEDICARE: ANDERSEN EYE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1477748754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSEN EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	1601 MARQUETTE ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-4196
Country	:	US
Telephone Number	:	989-249-8853
Fax Number	:	989-249-8842

Provider Business Practice Location Address
First Line	:	1601 MARQUETTE ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-4196
Country	:	US
Telephone Number	:	989-249-8853
Fax Number	:	989-249-8842

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	SUE GARDNER
Credential	:
Telephone Number	:	989-249-8853

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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Directions to “ANDERSEN EYE ASSOCIATES ” Practice Location

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