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NPI Code Detail

MEDICARE: SOUTHERN EYE PHYSICIANS CENTER, LLC

MEDICARE: SOUTHERN EYE PHYSICIANS CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2512G700152OTHERMSMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235316266
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN EYE PHYSICIANS CENTER, LLC
Provider Business Mailing Address
First Line : 1420 S 28TH AVE
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-3107
Country : US
Telephone Number : 601-264-3937
Fax Number : 601-264-5930
Provider Business Practice Location Address
First Line : 1420 S 28TH AVE
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-3107
Country : US
Telephone Number : 601-264-3937
Fax Number : 601-264-5930
Authorized Official
Title or Position : MANAGING MEMBER/PRESIDENT
Name : DR. KIPER C NELSON
Credential : M.D.
Telephone Number : 601-264-3937
Provider Enumeration Date : 01/22/2008
Last Update Date : 06/23/2021

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Directions to “SOUTHERN EYE PHYSICIANS CENTER, LLC ” Practice Location

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