Provider Demographics
NPI:1376593533
Name:SOUTHERN EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:SOUTHERN EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-571-0081
Mailing Address - Street 1:2801 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6474
Mailing Address - Country:US
Mailing Address - Phone:919-571-0081
Mailing Address - Fax:919-787-3591
Practice Address - Street 1:2801 BLUE RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6474
Practice Address - Country:US
Practice Address - Phone:919-571-0081
Practice Address - Fax:919-787-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000183820OtherHIGHMARK BCBS
NCCL944OtherRAILROAD MEDICARE
NC01395OtherBCBS CLINIC
NC7901395Medicaid
NC7901395Medicaid