Provider Demographics
NPI:1104262773
Name:SOUTHEAST VISION REHABILITATION, PLLC
Entity type:Organization
Organization Name:SOUTHEAST VISION REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRYAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-321-8233
Mailing Address - Street 1:1043 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3997
Mailing Address - Country:US
Mailing Address - Phone:423-321-8233
Mailing Address - Fax:423-321-8325
Practice Address - Street 1:1043 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3997
Practice Address - Country:US
Practice Address - Phone:423-321-8233
Practice Address - Fax:423-321-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty