Provider Demographics
NPI:1760886279
Name:SOUTHERN EYE CARE, O.D., PLLC
Entity Type:Organization
Organization Name:SOUTHERN EYE CARE, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:JANIK
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-271-4304
Mailing Address - Street 1:12441 BAYLEAF CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9168
Mailing Address - Country:US
Mailing Address - Phone:919-271-4303
Mailing Address - Fax:
Practice Address - Street 1:2114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8817
Practice Address - Country:US
Practice Address - Phone:919-271-4304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty