Provider Demographics
NPI:1437636396
Name:SAND VISION LLC
Entity Type:Organization
Organization Name:SAND VISION LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-973-3213
Mailing Address - Street 1:3000 OASIS GRAND BLVD APT 3107
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1646
Mailing Address - Country:US
Mailing Address - Phone:314-973-3213
Mailing Address - Fax:
Practice Address - Street 1:6891 DANIELS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1503
Practice Address - Country:US
Practice Address - Phone:314-973-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center