Provider Demographics
NPI:1538352703
Name:SOUTHERN EYE, LLC
Entity type:Organization
Organization Name:SOUTHERN EYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:ARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-876-6980
Mailing Address - Street 1:603 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4707
Mailing Address - Country:US
Mailing Address - Phone:985-876-6980
Mailing Address - Fax:985-876-6975
Practice Address - Street 1:603 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4707
Practice Address - Country:US
Practice Address - Phone:985-876-6980
Practice Address - Fax:985-876-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1544-575T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center