Provider Demographics
NPI:1518593367
Name:SAND VISION LLC
Entity Type:Organization
Organization Name:SAND VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-364-7346
Mailing Address - Street 1:6891 DANIELS PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1503
Mailing Address - Country:US
Mailing Address - Phone:727-364-7346
Mailing Address - Fax:
Practice Address - Street 1:706 SW PINE ISLAND RD # 102
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991
Practice Address - Country:US
Practice Address - Phone:239-451-5954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty