Healthcare Provider Details

I. General information

NPI: 1649569450
Provider Name (Legal Business Name): ANDERSEN EYE PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 CARDINAL PARK DR
SAGINAW MI
48604
US

IV. Provider business mailing address

PO BOX 5649
SAGINAW MI
48603-0649
US

V. Phone/Fax

Practice location:
  • Phone: 989-249-8853
  • Fax: 989-249-8842
Mailing address:
  • Phone: 989-249-8853
  • Fax: 989-249-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALICIA OCONNOR
Title or Position: CEO
Credential:
Phone: 989-341-7170