Andersen Eye Prosthetics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ANDERSEN EYE PROSTHETICS LLC

Practice address

5161 Cardinal Park Dr
Saginaw, MI 48604

Phone

(989) 249-8853

Fax

(989) 249-8842

NPI assigned

Apr 1, 2011

Organization subpart

No

Name

Alicia Oconnor

Title

Ceo

Phone

(989) 341-7170

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Andersen Eye Prosthetics LLC

  • Ocularist
  • Grand Rapids, MI
  • NPI 1518232040

  O20120330000069

  Same enrollment

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

  • Ocularist
  • Detroit, MI
  • NPI 1235510892

  6305019266

  Same PAC ID

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mike Bain

  • Ocularist
  • Saginaw, MI
  • NPI 1912086281
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 5, 2024.

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1649569450",
    "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": "989-249-8853",
            "fax_number": "989-249-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5161 CARDINAL PARK DR",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "48604",
            "telephone_number": "989-249-8853",
            "fax_number": "989-249-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSEN EYE PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-01",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-341-7170"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andersen Eye Associates
• Andersen Eye Associates, PLC
• Andersen Eye Associates, PLC
• Andersen Eye Associates, PLC
• Andersen Eye Associates, PLC
• Andersen Eye Surgery Center, LLC
• Alexander Anderson, PA-C
• Andrea Maria Anderson
• Clyde Anderson III
• Elise Anderson

• All providers in Saginaw, MI
• Prosthetic/Orthotic Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.