Healthcare Provider Details

I. General information

NPI: 1407843014
Provider Name (Legal Business Name): SOUTHEASTERN EYE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FARM BROOK DR SUITE B
LUMBERTON NC
28358-2178
US

IV. Provider business mailing address

106 FARM BROOK DR SUITE B
LUMBERTON NC
28358-2178
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-4856
  • Fax: 910-738-7999
Mailing address:
  • Phone: 910-738-4856
  • Fax: 910-738-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TIMOTHY SCOTT MOUSER
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 910-738-4856