Healthcare Provider Details

I. General information

NPI: 1932200664
Provider Name (Legal Business Name): SOUTHEASTERN RETINA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 OLD WEISGARBER RD
KNOXVILLE TN
37909-1291
US

IV. Provider business mailing address

9050 EXECUTIVE PARK DR STE 202A
KNOXVILLE TN
37923-4670
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-0811
  • Fax:
Mailing address:
  • Phone: 865-588-0811
  • Fax: 865-934-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW LAVERGHETTA
Title or Position: CEO
Credential: CEO
Phone: 865-588-0811