Healthcare Provider Details

I. General information

NPI: 1043643398
Provider Name (Legal Business Name): SOUTHERN EYE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 FURYS FERRY RD
MARTINEZ GA
30907-9059
US

IV. Provider business mailing address

503 FURYS FERRY RD
MARTINEZ GA
30907-9059
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-8899
  • Fax: 706-863-7822
Mailing address:
  • Phone: 706-860-8899
  • Fax: 706-863-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002458
License Number StateGA

VIII. Authorized Official

Name: DR. ROBERT R MORGAN
Title or Position: OWNER
Credential: O.D.
Phone: 706-860-8899