Healthcare Provider Details

I. General information

NPI: 1336850270
Provider Name (Legal Business Name): SOUTHEAST EYE INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10041 US HIGHWAY 19 STE A
PORT RICHEY FL
34668-3785
US

IV. Provider business mailing address

10041 US HIGHWAY 19 STE A
PORT RICHEY FL
34668-3785
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-0780
  • Fax:
Mailing address:
  • Phone: 727-868-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN EMERY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 727-868-0780