Provider Demographics
NPI:1457986267
Name:SEASIDE EYE ASSOCIATES SOUTH LLC
Entity type:Organization
Organization Name:SEASIDE EYE ASSOCIATES SOUTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-357-8096
Mailing Address - Street 1:PO BOX 4137
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2686
Mailing Address - Country:US
Mailing Address - Phone:843-357-8096
Mailing Address - Fax:843-357-8099
Practice Address - Street 1:640 MORSE AVE
Practice Address - Street 2:UNIT 11
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-357-8096
Practice Address - Fax:843-357-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD16659Medicaid