Provider Demographics
NPI:1316177488
Name:SOUTHERN EYE SPECIALISTS PC
Entity type:Organization
Organization Name:SOUTHERN EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:DANNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-7100
Mailing Address - Street 1:1909 HONEYSUCKLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4289
Mailing Address - Country:US
Mailing Address - Phone:334-699-7100
Mailing Address - Fax:
Practice Address - Street 1:1909 HONEYSUCKLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4289
Practice Address - Country:US
Practice Address - Phone:334-699-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16679207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicare PIN