Southeast Eye Group LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SOUTHEAST EYE GROUP LLC

Practice address

17 Hometown Way
Blairsville, GA 30512

Phone

(706) 896-3303

Fax

(706) 896-9485

NPI assigned

Jan 15, 2020

Organization subpart

Yes

Parent organization

GEORGIA VISION CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jose Matias Arencibia, O.D.NPI 1841264249

Title

President/Optometrist

Phone

(706) 896-3303

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Part of

Georgia Vision Center

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Georgia Vision Center

  • Optometrist
  • Hiawassee, GA
  • NPI 1982677357
  NPPES parent name

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose Matias Arencibia, OD

  • Optometrist
  • Hiawassee, GA
  • NPI 1841264249
  Medicare reassignment Care Compare group NPD Authorized official
• Alexa Reane Arencibia, OD

  • Optometrist
  • Clayton, GA
  • NPI 1164154324
  Medicare reassignment Care Compare group NPD
• Cassidy Coleman, OD

  • Optometrist
  • Blairsville, GA
  • NPI 1316615743
  Medicare reassignment Care Compare group NPD
• Hana Gabriella Coleman, O.D.

  • Optometrist
  • Blairsville, GA
  • NPI 1104440379
  Medicare reassignment Care Compare group NPD
• Stephen R Thurmond, O.D.

  • Optometrist
  • Clayton, GA
  • NPI 1669491437
  Medicare reassignment NPD
• William Dane Fritts, OD

  • Optometrist
  • Morehead, KY
  • NPI 1841864725

  GA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596499200000",
    "number": "1003456229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 HOMETOWN WAY",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "30512",
            "telephone_number": "706-896-3303",
            "fax_number": "706-896-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 HOMETOWN WAY",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "30512",
            "telephone_number": "706-896-3303",
            "fax_number": "706-896-9485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST EYE GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA VISION CENTER",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A",
        "authorized_official_last_name": "ARENCIBIA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "MATIAS",
        "authorized_official_title_or_position": "PRESIDENT/OPTOMETRIST",
        "authorized_official_telephone_number": "706-896-3303",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joelle Marie Smart, LMT, NMT
• Christopher Gerald Smith, PHARMD
• Megan Christine Smith, DO
• Wendy L Smith, M.D.
• Rebecca Danielle Snider, FNP
• Southland Medical Group, LLC
• Southland Union Emergency Medical Services, LLC
• Kimberly Albury Spade, M.ED., CCC-SLP
• Gwen Sparkman, M.ED. CCC-SLP
• Debra D Spaulding

• Optometrist in Blairsville, GA
• Providers in Blairsville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.