Healthcare Provider Details

I. General information

NPI: 1750535621
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

4 OKATIE CENTER BLVD. STE. 102
OKATIE SC
29909
US

IV. Provider business mailing address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-3333
  • Fax:
Mailing address:
  • Phone: 843-705-3333
  • Fax: 843-705-3334

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