Provider Demographics
NPI:1174261218
Name:ANDERSEN EYE PROSTHETICS LLC
Entity type:Organization
Organization Name:ANDERSEN EYE PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-797-2400
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:989-341-7171
Mailing Address - Fax:989-249-1054
Practice Address - Street 1:39000 7 MILE RD STE 2400
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1006
Practice Address - Country:US
Practice Address - Phone:989-797-2400
Practice Address - Fax:989-245-1035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSEN EYE PROSTHETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-26
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty