Provider Demographics
NPI:1518232040
Name:ANDERSEN EYE PROSTHETICS LLC
Entity Type:Organization
Organization Name:ANDERSEN EYE PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-341-7170
Mailing Address - Street 1:5161 CARDINAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9435
Mailing Address - Country:US
Mailing Address - Phone:989-797-2400
Mailing Address - Fax:989-249-1035
Practice Address - Street 1:2757 LEONARD ST NE
Practice Address - Street 2:STE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5807
Practice Address - Country:US
Practice Address - Phone:989-797-2400
Practice Address - Fax:989-249-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5001000027156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty