Provider Demographics
NPI:1649569450
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:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-341-7170
Mailing Address - Street 1:PO BOX 5649
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0649
Mailing Address - Country:US
Mailing Address - Phone:989-249-8853
Mailing Address - Fax:989-249-8842
Practice Address - Street 1:5161 CARDINAL PARK DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-249-8853
Practice Address - Fax:989-249-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty