Provider Demographics
NPI:1467111278
Name:SOUTHEAST EYE INSTITUTE, PA
Entity Type:Organization
Organization Name:SOUTHEAST EYE INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:PRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-541-4469
Mailing Address - Street 1:3935 TAMPA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3106
Mailing Address - Country:US
Mailing Address - Phone:727-541-4469
Mailing Address - Fax:727-546-9661
Practice Address - Street 1:10755 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5420
Practice Address - Country:US
Practice Address - Phone:727-392-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty