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General NPI Number Information
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NPI Number | 1427113554
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Entity Type | Organization
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Legal Business Name | SEASIDE OPHTHALMOLOGY, INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3303A GLYNN AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4406
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Country | US
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Telephone | 912-466-9500
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Fax | 912-466-9922
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Provider Business Mailing Address
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Address Line | 3303A GLYNN AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4406
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Country | US
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Telephone | 912-466-9500
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Fax | 912-466-9922
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA J CLARK
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Credential |
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Telephone | 912-466-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 052897
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License Number State | GA
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