GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC (NPI# 1700039740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700039740 |
| Entity Type | Organization |
| Organization Name | GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC |
| Practice Address |
4720 Waters Ave Savannah GA 31404-6292 |
| Mailing Address |
Po Box 102635 Atlanta GA 30368-2635 |
| Practice Telephone | 9123544800 |
| Practice Fax Number | 9126295821 |
| Mailing Telephone | 9123544800 |
| Mailing Fax Number | 9126295821 |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2011-12-22 |
| Authorized Official Name | MRS. KATHY HEGAN (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 9126295929 |
| Is Organization Subpart | Y |
| Parent Organization Name | GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| Y | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICAID OD | DAG976 | 01 |
| SC | MEDICAID MD | GPA977 | 01 |
| SC | MEDICAID MD- BLUFFTON | GP5020 | 01 |
| SC | MEDICAID OD - BLUFFTON | DA9642 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124519954 | Georgia Eye Institute of The Southeast, LLC | Ophthalmology | 1000 Towne Center Blvd Ste 806, Pooler, GA 31322-4070 | 2018-05-29 |
| 1154714574 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 104 Andrews Street, Suite 112, Vidalia, GA 30474 | 2015-03-10 |
| 1639410756 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 741 Weeping Willow Drive, Hinesville, GA 31313 | 2013-03-14 |
| 1992058234 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 3303 Glynn Avenue, Brunswick, GA 31520-4406 | 2012-10-24 |
| 1417200148 | Georgia Eye Institute of The Southeast, LLC | Ophthalmology | 80 Baylor Way, Bluffton, SC 29910-8902 | 2012-10-18 |
| 1144474016 | Georgia Eye Institute of The Southeast, LLC | Ophthalmology | 6162 Hwy 21 South, Rincon, GA 31326-5164 | 2008-11-05 |
| 1619121589 | Georgia Eye Institute of The Southeast, LLC | Ophthalmology | 2429 Us Highway 17, Richmond Hill, GA 31324-3397 | 2008-11-05 |
| 1750535621 | Georgia Eye Institute of The Southeast, LLC | Ophthalmology | 4 Okatie Center Blvd. Ste. 102, Okatie, SC 29909 | 2008-11-05 |
| 1508119207 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 1000 Towne Center Blvd, Pooler, GA 31322-4052 | 2012-10-18 |
| 1386997013 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 198 Sw Broad St, Jesup, GA 31545-1101 | 2012-10-18 |
| Street Address |
4720 WATERS AVE |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404-6292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083617419 | Shari Carney | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404 | 2005-05-31 |
| 1366734147 | Thomas J Kandl | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2011-05-11 |
| 1356575377 | Georgia Eye Institute Surgery Center LLC | Clinic/Center | 4720 Waters Ave, Savannah, GA 31404-6292 | 2009-05-05 |
| 1306006226 | Robin Ray | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2008-06-13 |
| 1508058181 | Memorial Health University Medical Center | General Acute Care Hospital | 4720 Waters Ave, Savannah, GA 31404-6292 | 2007-08-16 |
| 1740487131 | Jennifer Goodrich Bromley | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2007-06-28 |
| 1952323990 | Georgia Eye Institute, Inc. | Optometrist | 4720 Waters Ave, Savannah, GA 31404-6292 | 2006-07-25 |
| 1003831371 | Nicholas R. Bollin | Optometrist | 4720 Waters Ave, Savannah, GA 31404-6292 | 2006-07-13 |
| 1437198983 | Joseph R Gussler | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2006-06-06 |
| 1508805052 | David D Kim | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2006-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457654469 | Henry George Croci | Ophthalmology | 11 Windwalk Ln, Savannah, GA 31411-2222 | 2010-12-13 |
| 1730119280 | Advanced Eye Center, Inc. | Ophthalmology | 34 Medical Arts, Savannah, GA 31405 | 2006-07-03 |
| 1336184258 | Angela M Rowden | Ophthalmology | 900 Mohawk Street, Ste E, Savannah, GA 31419 | 2006-06-17 |
| 1770530578 | Elizabeth Helen Landa | Ophthalmology | 8 Stephenson Ave, Savannah, GA 31405-5802 | 2006-05-27 |
| 1427016534 | Charles L Harris | Ophthalmology | 836 East 65th St, Bldg 34, Savannah, GA 31405-6007 | 2006-05-01 |
| 1083617419 | Shari Carney | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404 | 2005-05-31 |
| 1407194137 | Joseph J Scuderi Md Pa | Ophthalmology | 5354 Reynolds St, Suite 411, Savannah, GA 31405-6007 | 2013-01-31 |
| 1366734147 | Thomas J Kandl | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2011-05-11 |
| 1336380658 | Campen Eye Care LLC | Ophthalmology | 5102 Paulsen St, Building 4, Savannah, GA 31405-4601 | 2009-03-17 |
| 1306006226 | Robin Ray | Ophthalmology | 4720 Waters Ave, Savannah, GA 31404-6292 | 2008-06-13 |
| Find all providers in SAVANNAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.