Provider Demographics
NPI:1154714574
Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Entity type:Organization
Organization Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRARTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-5929
Mailing Address - Street 1:4720 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6292
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-5821
Practice Address - Street 1:104 ANDREWS STREET, SUITE 112
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474
Practice Address - Country:US
Practice Address - Phone:912-537-4447
Practice Address - Fax:912-537-2743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-10
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty