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General NPI Number Information
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NPI Number | 1104952928
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Entity Type | Organization
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Legal Business Name | SOUTHEAST EYE ASSOCIATES, PLLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 1403 CUMBERLAND AVE SUITE A, BOX 979
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1158
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Country | US
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Telephone | 606-248-2549
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Fax | 606-248-9188
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Provider Business Mailing Address
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Address Line | 1403 CUMBERLAND AVE SUITE A
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1158
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Country | US
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Telephone | 606-248-2549
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Fax | 606-248-9188
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA S HOWARD
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Credential | OD
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Telephone | 606-248-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1082 DT
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License Number State | KY
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