Andersen Eye Prosthetics, LLC

Primary specialty

OcularistTaxonomy code 156FX1700X

Legal business name

ANDERSEN EYE PROSTHETICS, LLC

Practice address

4719 Saint Antoine St
Detroit, MI 48201-1423

Phone

(989) 249-1030

NPI assigned

Jun 9, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gregory Carmen Hazen, M.D.

Title

Medical Director

Phone

(989) 249-1030

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Andersen Eye Prosthetics LLC

  • Durable Medical Equipment & Medical Supplies
  • Livonia, MI
  • NPI 1174261218

  6305019266

  Same PAC ID
• Andersen Eye Prosthetics LLC

  • Ocularist
  • Grand Rapids, MI
  • NPI 1518232040

  6305019266

  Same PAC ID
• Andersen Eye Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Saginaw, MI
  • NPI 1649569450

  6305019266

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Andersen Eye Prosthetics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Andersen Eye Prosthetics LLC

  • Durable Medical Equipment & Medical Supplies
  • Livonia, MI
  • NPI 1174261218
  NPD tax ID
• Andersen Eye Prosthetics LLC

  • Ocularist
  • Grand Rapids, MI
  • NPI 1518232040
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1235510892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5649",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486030649",
            "telephone_number": "989-249-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4719 SAINT ANTOINE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011423",
            "telephone_number": "989-249-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSEN EYE PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "HAZEN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "CARMEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "989-249-1030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anchorpoint Family Services, Inc.
• Almeta M Andary, FNP
• Lourdes Villalobos Andaya, MD
• Andel Therapeutic Solutions, LLC
• Emilyn Rose Anderi, MD
• Courtney Erin Andersen, O.D., M.S.
• Judith C Andersen, MD
• Taryn Bailey Andersen, LLMSW
• Teresa Ryan Andersen, BS
• Anderson House LLC

• All providers in Detroit, MI
• Ocularist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.