Provider Demographics
NPI:1093953002
Name:SOUTH EASTERN EYE CENTER, OFFICE OF DR NACONDUS GAMBLE
Entity Type:Organization
Organization Name:SOUTH EASTERN EYE CENTER, OFFICE OF DR NACONDUS GAMBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NACONDUS
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:912-876-1101
Mailing Address - Street 1:PO BOX 3700
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-3700
Mailing Address - Country:US
Mailing Address - Phone:912-748-3926
Mailing Address - Fax:912-877-4244
Practice Address - Street 1:345 LINDQUIST
Practice Address - Street 2:BLDG. 71
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:31314-0345
Practice Address - Country:US
Practice Address - Phone:912-876-1101
Practice Address - Fax:912-877-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty