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General NPI Number Information
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NPI Number | 1649094699
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Entity Type | Organization
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Legal Business Name | SANDHILL OCULAR PROSTHETICS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 112 TREEMONTE DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-7953
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Country | US
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Telephone | 386-880-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 112 TREEMONTE DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-7953
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Country | US
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Telephone | 386-218-0445
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Fax | 386-244-9773
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Authorized Official
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Title or Position | OWNER
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Name | KORI JAHRLING MALOUIN
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Credential | BCO, BADO
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Telephone | 386-218-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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