Southern Eye Center P.a. II

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

010 Issued in MS

Legal business name

SOUTHERN EYE CENTER P.A. II

Doing business as

Southern Eye Center of Excellence

Practice address

1420 S 28TH Ave
Hattiesburg, MS 39402-3107

Phone

(601) 264-3937

Fax

(601) 264-5930

NPI assigned

May 24, 2005

Organization subpart

No

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

Authorized official

Name

Mr. John Weems

Title

Administrator

Phone

(601) 264-3937

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Southern Eye Center of Excellence Doing business as

Locations

Practitioners 3

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

• Jaime Jimenez Agosto, M.D.

  • Ophthalmology Physician
  • Hattiesburg, MS
  • NPI 1932102951
  NPD (past)
• Kiper Cecil Nelson, M.D.

  • Ophthalmology Physician
  • Hattiesburg, MS
  • NPI 1548263312
  NPD (past)
• Wade Tucker, M.D.

  • Ophthalmology Physician
  • Hattiesburg, MS
  • NPI 1598299810
  NPD (past)

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218758400000",
    "number": "1265435010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023107",
            "telephone_number": "601-264-3937",
            "fax_number": "601-264-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023107",
            "telephone_number": "601-264-3937",
            "fax_number": "601-264-5930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EYE CENTER P.A. II",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2008-08-15",
        "status": "A",
        "authorized_official_last_name": "WEEMS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-264-3937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MS",
            "license": "010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770066",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014315",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Eye Center of Excellence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Southern Bone& Joint Specialists
• Southern Brace and Limb
• Southern Eye Center P.a. II
• Southern Eye Center P.a. II
• Southern Eye Physicians Center, LLC
• Southern Eye Surgery Center LLC
• Southern Eye Surgery Center LLC

• Medical Specialty Clinic/Center in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Medical Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.