Provider Demographics
NPI:1407843014
Name:SOUTHEASTERN EYE CARE, PA
Entity Type:Organization
Organization Name:SOUTHEASTERN EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-4856
Mailing Address - Street 1:106 FARM BROOK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2178
Mailing Address - Country:US
Mailing Address - Phone:910-738-4856
Mailing Address - Fax:910-738-7999
Practice Address - Street 1:106 FARM BROOK DR
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2178
Practice Address - Country:US
Practice Address - Phone:910-738-4856
Practice Address - Fax:910-738-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDC2898OtherRR MEDICARE
NC8913746Medicaid
NC8913746Medicaid
NC2340498Medicare PIN