Provider Demographics
NPI:1699591636
Name:SOUTHEAST EYE INSTITUTE, PA
Entity type:Organization
Organization Name:SOUTHEAST EYE INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENDIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-343-3004
Mailing Address - Street 1:6950 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1210
Mailing Address - Country:US
Mailing Address - Phone:727-343-3004
Mailing Address - Fax:
Practice Address - Street 1:6950 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1210
Practice Address - Country:US
Practice Address - Phone:727-343-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty