Southeastern Eye Clinic PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPTO01603 Issued in GA

Legal business name

SOUTHEASTERN EYE CLINIC PC

Doing business as

Vision Source - Professional Eye Care

Practice address

214 Savannah Ave
Statesboro, GA 30458-5165

Phone

(912) 764-5609

Fax

(912) 764-7786

NPI assigned

Dec 13, 2006

Last updated

Jun 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Horace E Deal, ODNPI 1851373567

Title

Owner, Provider

Phone

(912) 764-5609

Specialties & licenses 1

Addresses

Other names 1

• Vision Source - Professional Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Horace E Deal, OD

  • Optometrist
  • Statesboro, GA
  • NPI 1851373567
  Medicare reassignment Care Compare group NPD Authorized official
• Dylan Piette, OD

  • Optometrist
  • Statesboro, GA
  • NPI 1366003410
  Medicare reassignment Care Compare group NPD
• Connie June Barnett, RN, MSN, APRN-BC

  • Adult Health Nurse Practitioner
  • Statesboro, GA
  • NPI 1043363575
  NPD (past)
• Ogechi Helen Mbakwe, MD

  • Internal Medicine Physician
  • Statesboro, GA
  • NPI 1992861603
  NPD (past)
• Mona Dennison Smith, NURSE PRACTITIONER

  • Acute Care Nurse Practitioner
  • Statesboro, GA
  • NPI 1669904884
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1225199979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 SAVANNAH AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585165",
            "telephone_number": "912-764-5609",
            "fax_number": "912-764-7786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 SAVANNAH AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585165",
            "telephone_number": "912-764-5609",
            "fax_number": "912-764-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN EYE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "DEAL",
        "authorized_official_first_name": "HORACE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER, PROVIDER",
        "authorized_official_telephone_number": "912-764-5609",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPTO01603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source - Professional Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Southern Health and Wellness
• Southern Home Hearing LLC.
• Southern Hospitality Adult Day Health Agency LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.