Provider Demographics
NPI:1639248834
Name:ANDERSEN EYE ASSOCIATES
Entity Type:Organization
Organization Name:ANDERSEN EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-799-2860
Mailing Address - Street 1:3210 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3475
Mailing Address - Country:US
Mailing Address - Phone:989-799-2860
Mailing Address - Fax:
Practice Address - Street 1:3210 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3475
Practice Address - Country:US
Practice Address - Phone:989-799-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002318332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944346425Medicaid
MI1056440004Medicare NSC
MIT33560Medicare UPIN
MI944346425Medicaid