NPIMap

Organization Active NPI

Lifetime Vision Care

  • Optometrist
  • Bend, OR
National Provider Identifier
1508961731
Registry record updated Jul 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3213ATI Issued in OR
Legal business name
LIFETIME VISION CARE
Practice address
901 NW Carlon Ave
Suite 2
Bend, OR 97703-2636
Phone
(541) 382-3242
Fax
(541) 317-3579
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Derri Sandberg, O.D.NPI 1831397306
Title
Owner
Phone
(541) 382-3242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3213ATI OR Primary

Addresses

Primary practice location

901 NW Carlon Ave
Suite 2
Bend, OR 97703-2636

Mailing address

901 NW Carlon Ave
Suite 2
Bend, OR 97703-2636
Phone (541) 382-3242

Other identifiers 1

IdentifierTypeStateIssuer
R163759OtherORMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Vision Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

901 NW Carlon Ave
Ste 2
Bend, OR 97703
Phone (541) 382-3242

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1508961731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 NW CARLON AVE",
            "address_2": "SUITE 2",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977032636",
            "telephone_number": "541-382-3242",
            "fax_number": "541-317-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NW CARLON AVE",
            "address_2": "SUITE 2",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977032636",
            "telephone_number": "541-382-3242",
            "fax_number": "541-317-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME VISION CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "SANDBERG",
        "authorized_official_first_name": "DERRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-382-3242",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3213ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R163759",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.