Provider Demographics
NPI:1881625770
Name:SOUTHERN EYECARE ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTHERN EYECARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-876-1492
Mailing Address - Street 1:2503 JEFFERY DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1918
Mailing Address - Country:US
Mailing Address - Phone:423-876-1492
Mailing Address - Fax:423-876-0159
Practice Address - Street 1:5764 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3727
Practice Address - Country:US
Practice Address - Phone:423-876-1492
Practice Address - Fax:423-876-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD000001665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN410047075OtherRAILROAD MEDICARE
TN4022309OtherBCBS
TN910601OtherHEALTHSPRING
TNU62763Medicare UPIN
TN410047075OtherRAILROAD MEDICARE