Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 US HIGHWAY 17
RICHMOND HILL GA
31324-3397
US

IV. Provider business mailing address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-6091
  • Fax: 912-756-6098
Mailing address:
  • Phone: 912-354-4800
  • Fax: 912-629-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICA LEIGH MORELAND
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 912-354-4800