Provider Demographics
NPI:1588867832
Name:SOUTHEASTER OCULAR PROSTHETICS
Entity type:Organization
Organization Name:SOUTHEASTER OCULAR PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-939-1990
Mailing Address - Street 1:700 18TH ST S
Mailing Address - Street 2:SUITE #402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1856
Mailing Address - Country:US
Mailing Address - Phone:205-939-1990
Mailing Address - Fax:
Practice Address - Street 1:700 18TH ST S
Practice Address - Street 2:SUITE #402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1856
Practice Address - Country:US
Practice Address - Phone:205-939-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier