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General NPI Number Information
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NPI Number | 1275104853
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Entity Type | Organization
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Legal Business Name | SOUTHERN VISION CARE, LLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 24 GLENDALE AVE STE F
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City | BAXLEY
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State | GA
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Zip | 31513-0245
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Country | US
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Telephone | 912-705-7096
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Fax | 912-705-7097
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Provider Business Mailing Address
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Address Line | 24 GLENDALE AVE STE F
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City | BAXLEY
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State | GA
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Zip | 31513-0245
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Country | US
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Telephone | 912-705-7096
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Fax | 912-705-7097
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL LLOYD MASON
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Credential | OD
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Telephone | 912-375-2516
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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 |
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License Number State |
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