Organization · NPI-2

Andersen Eye Prosthetics, LLC

Technician/Technologist, Ocularist · Detroit, MI

NPI number1235510892
StatusActive
Last updated in NPPESFeb 24, 2016

Details

NPI
1235510892
Entity type
Organization (NPI-2)
Legal business name
Andersen Eye Prosthetics, LLC
Organization subpart
No
Enumeration date
Jun 9, 2015
Last updated
Feb 24, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
156FX1700X Technician/Technologist, Ocularist––Yes

Practice location

4719 Saint Antoine St
Detroit, MI 48201-1423

Phone 989-249-1030

Mailing address

Po Box 5649
Saginaw, MI 48603-0649

Phone 989-249-1030

Authorized official

Gregory Carmen Hazen
Medical Director
9892491030

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