Provider Demographics
NPI:1275104853
Name:SOUTHERN VISION CARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-375-2516
Mailing Address - Street 1:24 GLENDALE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0245
Mailing Address - Country:US
Mailing Address - Phone:912-705-7096
Mailing Address - Fax:912-705-7097
Practice Address - Street 1:24 GLENDALE AVE STE F
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0245
Practice Address - Country:US
Practice Address - Phone:912-705-7096
Practice Address - Fax:912-705-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty