MEDICARE: SOUTHEAST EYE INSTITUTE, PA

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
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1467111278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST EYE INSTITUTE, PA

Provider Business Mailing Address
First Line	:	10755 PARK BLVD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-5420
Country	:	US
Telephone Number	:	727-392-0907
Fax Number	:

Provider Business Practice Location Address
First Line	:	10755 PARK BLVD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-5420
Country	:	US
Telephone Number	:	727-392-0907
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	NATHAN EMERY
Credential	:
Telephone Number	:	727-541-4469

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/10/2025

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Directions to “SOUTHEAST EYE INSTITUTE, PA ” Practice Location

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