Provider Demographics
NPI:1275885279
Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Entity Type:Organization
Organization Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-5929
Mailing Address - Street 1:445 S MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4333
Mailing Address - Country:US
Mailing Address - Phone:912-368-2522
Mailing Address - Fax:912-368-6437
Practice Address - Street 1:445 S MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4333
Practice Address - Country:US
Practice Address - Phone:912-368-2522
Practice Address - Fax:912-368-6437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty