Provider Demographics
NPI:1316020043
Name:SOUTHERN EYE CENTER, PC
Entity Type:Organization
Organization Name:SOUTHERN EYE CENTER, PC
Other - Org Name:SOUTHERN EYE CENTER, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EANES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-247-2020
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-247-2020
Mailing Address - Fax:229-247-5600
Practice Address - Street 1:2310 N PATTERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2568
Practice Address - Country:US
Practice Address - Phone:229-247-2020
Practice Address - Fax:229-247-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002069152W00000X
GA025970174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP343Medicare ID - Type UnspecifiedGEORGIA MEDICARE
GA0686710001Medicare NSC