Organization
LIFETIME VISION CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRI SANDBERG O.D. (OWNER)
(541) 382-3242
Entity
Organization
Contact information
Practice address
901 NW CARLON AVE, SUITE 2, BEND, OR 97703-2636
(541) 382-3242
(541) 317-3579
Mailing address
901 NW CARLON AVE, SUITE 2, BEND, OR 97703-2636
(541) 382-3242
(541) 317-3579
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3213ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R163759
MEDICARE PTAN
OR
Enumeration date
09/13/2006
Last updated
07/14/2015
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