Provider Demographics
NPI:1912188822
Name:SOUTHERN EYE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHERN EYE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-344-3556
Mailing Address - Street 1:3071 CAMPBELLTON RD SW
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-5441
Mailing Address - Country:US
Mailing Address - Phone:404-344-3556
Mailing Address - Fax:404-344-3500
Practice Address - Street 1:3071 CAMPBELLTON RD SW
Practice Address - Street 2:SUITE #1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-5441
Practice Address - Country:US
Practice Address - Phone:404-344-3556
Practice Address - Fax:404-344-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700262Medicare PIN