Provider Demographics
NPI:1477748754
Name:ANDERSEN EYE ASSOCIATES
Entity type:Organization
Organization Name:ANDERSEN EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-249-8853
Mailing Address - Street 1:1601 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4196
Mailing Address - Country:US
Mailing Address - Phone:989-249-8853
Mailing Address - Fax:989-249-8842
Practice Address - Street 1:1601 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4196
Practice Address - Country:US
Practice Address - Phone:989-249-8853
Practice Address - Fax:989-249-8842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSEN EYE ASSOCIATES LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M03110Medicare PIN