Provider Demographics
NPI:1750478186
Name:SOUTHERN EYE ASSOCIATES LTD
Entity Type:Organization
Organization Name:SOUTHERN EYE ASSOCIATES LTD
Other - Org Name:HARRIS EYE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHRONISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-935-6396
Mailing Address - Street 1:901 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4854
Mailing Address - Country:US
Mailing Address - Phone:870-239-2251
Mailing Address - Fax:870-239-6017
Practice Address - Street 1:901 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4854
Practice Address - Country:US
Practice Address - Phone:870-239-2251
Practice Address - Fax:870-239-6017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN EYE ASSOCIATES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC0764OtherRAILROAD MEDICARE
ARDC0764OtherRAILROAD MEDICARE
AR0348860005Medicare NSC