Healthcare Provider Details

I. General information

NPI: 1477466944
Provider Name (Legal Business Name): SOUTHERN EYES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 SOUTHERN BLVD
BRONX NY
10459-3401
US

IV. Provider business mailing address

965 SOUTHERN BLVD
BRONX NY
10459-3401
US

V. Phone/Fax

Practice location:
  • Phone: 347-269-8445
  • Fax:
Mailing address:
  • Phone: 347-269-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: WALTER NESSES
Title or Position: OWNER
Credential:
Phone: 858-692-6338