Provider Demographics
NPI:1649094699
Name:SANDHILL OCULAR PROSTHETICS LLC
Entity type:Organization
Organization Name:SANDHILL OCULAR PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:JAHRLING
Authorized Official - Last Name:MALOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCO, BADO
Authorized Official - Phone:386-218-0445
Mailing Address - Street 1:112 TREEMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7953
Mailing Address - Country:US
Mailing Address - Phone:386-218-0445
Mailing Address - Fax:386-244-9773
Practice Address - Street 1:112 TREEMONTE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7953
Practice Address - Country:US
Practice Address - Phone:386-880-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty