Provider Demographics
NPI:1669680799
Name:SOUTHEASTERN OPTICAL, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN OPTICAL, INC.
Other - Org Name:CARL ZEISS VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-989-8644
Mailing Address - Street 1:6490 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5159
Mailing Address - Country:US
Mailing Address - Phone:540-989-8644
Mailing Address - Fax:540-772-0074
Practice Address - Street 1:6490 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-5159
Practice Address - Country:US
Practice Address - Phone:540-989-8644
Practice Address - Fax:540-772-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier