Provider Demographics
NPI:1972059814
Name:SOUTHEAST VISION LLC
Entity Type:Organization
Organization Name:SOUTHEAST VISION LLC
Other - Org Name:VISION GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-209-2600
Mailing Address - Street 1:106 WEST VETERANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832
Mailing Address - Country:US
Mailing Address - Phone:334-209-2600
Mailing Address - Fax:
Practice Address - Street 1:106 WEST VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832
Practice Address - Country:US
Practice Address - Phone:334-209-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier