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General NPI Number Information
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NPI Number | 1386503670
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Entity Type | Organization
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Legal Business Name | SOUTHEAST VISION AND AESTHETICS
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 8390 N HIGHWAY 27
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City | ROCK SPRING
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State | GA
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Zip | 30739-2103
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Country | US
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Telephone | 706-375-1720
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Fax |
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Provider Business Mailing Address
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Address Line | 72 BILTMORE DR
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City | RINGGOLD
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State | GA
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Zip | 30736-3720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LYDIA GEABOU
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Credential | OD
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Telephone | 714-317-4195
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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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