Provider Demographics
NPI:1770770398
Name:SOUTHERN EYE INSTITUTE
Entity type:Organization
Organization Name:SOUTHERN EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-355-0115
Mailing Address - Street 1:720 N OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3043
Mailing Address - Country:US
Mailing Address - Phone:904-355-0115
Mailing Address - Fax:904-355-5602
Practice Address - Street 1:720 N OCEAN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3043
Practice Address - Country:US
Practice Address - Phone:904-355-0115
Practice Address - Fax:904-355-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375356500Medicaid
FL80878OtherBLUE CROSS BLUE SHIELD
FL180025854OtherRAIL ROAD MEDICARE