Provider Demographics
NPI:1417200148
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 1:80 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8902
Mailing Address - Country:US
Mailing Address - Phone:866-325-7941
Mailing Address - Fax:912-952-7946
Practice Address - Street 1:80 BAYLOR WAY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8902
Practice Address - Country:US
Practice Address - Phone:866-352-7974
Practice Address - Fax:912-352-7946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA EYE INSTITUTE OF THE SOTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty