Provider Demographics
NPI:1003456229
Name:SOUTHEAST EYE GROUP LLC
Entity Type:Organization
Organization Name:SOUTHEAST EYE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MATIAS
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-896-3303
Mailing Address - Street 1:17 HOMETOWN WAY
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512
Mailing Address - Country:US
Mailing Address - Phone:706-896-3303
Mailing Address - Fax:706-896-9485
Practice Address - Street 1:17 HOMETOWN WAY
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-896-3303
Practice Address - Fax:706-896-9485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA VISION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty