Provider Demographics
NPI:1073299244
Name:SOUTHERN VISION CENTER LLC
Entity Type:Organization
Organization Name:SOUTHERN VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIPER
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5144
Mailing Address - Street 1:2901 ARLINGTON LOOP
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7101
Mailing Address - Country:US
Mailing Address - Phone:601-268-5144
Mailing Address - Fax:601-268-5149
Practice Address - Street 1:317 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2725
Practice Address - Country:US
Practice Address - Phone:601-268-5144
Practice Address - Fax:601-268-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty