MEDICARE: GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619121589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC

Provider Business Mailing Address
First Line	:	4720 WATERS AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31404-6292
Country	:	US
Telephone Number	:	912-354-4800
Fax Number	:	912-629-5821

Provider Business Practice Location Address
First Line	:	2429 US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3397
Country	:	US
Telephone Number	:	912-756-6091
Fax Number	:	912-756-6098

Authorized Official
Title or Position	:	DIRECTOR, REVENUE CYCLE
Name	:	ERICA LEIGH MORELAND
Credential	:
Telephone Number	:	912-354-4800

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	07/16/2025

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