MEDICARE: SOUTHEAST EYE INSTITUTE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336850270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST EYE INSTITUTE, PA

Provider Business Mailing Address
First Line	:	10041 US HIGHWAY 19 STE A
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3785
Country	:	US
Telephone Number	:	727-868-0780
Fax Number	:

Provider Business Practice Location Address
First Line	:	10041 US HIGHWAY 19 STE A
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3785
Country	:	US
Telephone Number	:	727-868-0780
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	NATHAN EMERY
Credential	:
Telephone Number	:	727-868-0780

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/10/2025

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Directions to “SOUTHEAST EYE INSTITUTE, PA ” Practice Location

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