Healthcare Provider Details

I. General information

NPI: 1174261218
Provider Name (Legal Business Name): ANDERSEN EYE PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 7 MILE RD STE 2400
LIVONIA MI
48152-1006
US

IV. Provider business mailing address

PO BOX 5649
SAGINAW MI
48603-0649
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-2400
  • Fax: 989-245-1035
Mailing address:
  • Phone: 989-341-7171
  • Fax: 989-249-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY HAZEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 989-797-2400