NPIMap

Organization Active NPI

Southern Eyecare, P.C.

  • Optometrist
  • Hazlehurst, GA
National Provider Identifier
1407029465
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT001506 Issued in GA
Legal business name
SOUTHERN EYECARE, P.C.
Practice address
25 Cross St
Hazlehurst, GA 31539-6427
Phone
(912) 375-2516
Fax
(912) 379-0755
NPI assigned
Apr 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Authorized official

Name
Michael Lloyd Mason, ODNPI 1982686564
Title
Owner
Phone
(912) 375-2516

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPT001506 GA Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPT002403 GA

Addresses

Primary practice location

25 Cross St
Hazlehurst, GA 31539-6427

Mailing address

P O Box 430
25 Cross St
Hazlehurst, GA 31539-0430
Phone (912) 375-2516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080626000490 GA Part B Supplier - Clinic/Group Practice 1557433190 Receives reassigned benefits from 2 practitioners
Practice locations: Hazlehurst, GA
O20100930019680 GA DME Supplier - Physician - Optometrist 1557433190 Practice locations: Hazlehurst, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Southern Eyecare PC25 Cross St, Hazlehurst, GA 31539-6427(912) 375-2516 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2001

National Provider Directory

National Provider Directory

Locations

25 Cross St
Hazlehurst, GA 31539
Phone (912) 375-2516

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1407029465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 430",
            "address_2": "25 CROSS ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315390430",
            "telephone_number": "912-375-2516",
            "fax_number": "912-379-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CROSS ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315396427",
            "telephone_number": "912-375-2516",
            "fax_number": "912-379-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EYECARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LLOYD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-375-2516",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001506",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002403",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; 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.