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SOUTHEASTERN EYE CLINICS PC NPI 1225199979


NPI Information

NPI: 1225199979
Provider Name: SOUTHEASTERN EYE CLINICS PC

Doing Business As: PROFESSIONAL EYECARE OF STATESBORO

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 11D2112446

Address:
214 SAVANNAH AVE
STATESBORO, GA
ZIP 30458
Phone: (912) 764-5609
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SOUTHEASTERN EYE CLINICS PC is an optometrist in Statesboro, GA. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. SOUTHEASTERN EYE CLINICS PC NPI is 1225199979. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Professional Eyecare Of Statesboro.

The provider's business location address is:

214 SAVANNAH AVE
STATESBORO, GA
ZIP 30458-165
Phone: (912) 764-5609
Fax: (912) 764-7786

The provider's authorized official is Horace Edsel Deal .
The authorized official title is President and has the following contact phone number (912) 764-5609.

The CLIA number assigned to this NPI record is 11D2112446 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/13/2006 and was last updated on 5/1/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152W00000XOptometristOPTO01603GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
141ZCDRMMEDICARE PINGEORGIA
2202G701012MEDICARE PINGEORGIA
33899110001MEDICARE NSCGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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