NPIMap

Organization Active NPI

Southern Eye Associates LTD

  • Ophthalmology Physician
  • Jonesboro, AR
National Provider Identifier
1669486528
Registry record updated Sep 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MC-1284 Issued in AR
Legal business name
SOUTHERN EYE ASSOCIATES LTD
Practice address
601 E Matthews Ave
Jonesboro, AR 72401-3145
Phone
(870) 935-6396
Fax
(870) 935-4063
NPI assigned
Jul 28, 2006
Last updated
Sep 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2015

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

Authorized official

Name
Kelly E Chronister, RN
Title
Administrator
Phone
(870) 935-6396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MC-1284 AR
Ophthalmology Physician 207W00000X MC-1284 AR Primary

Addresses

Primary practice location

601 E Matthews Ave
Jonesboro, AR 72401-3145

Mailing address

601 E Matthews Ave
Jonesboro, AR 72401-3145
Phone (870) 935-6396

Other identifiers 3

IdentifierTypeStateIssuer
116840002MedicaidAR
CT1713OtherARRAILROAD MEDICARE
503329807OtherMOMISSOURI MEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121000334 AR Part B Supplier - Clinic/Group Practice 4688576739 Receives reassigned benefits from 11 practitioners
Practice locations: Jonesboro, AR

National Provider Directory

National Provider Directory
Tax ID family
Southern Eye Associates LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

601 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-6396

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441152000000",
    "number": "1669486528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-935-6396",
            "fax_number": "870-935-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-935-6396",
            "fax_number": "870-935-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EYE ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-09-02",
        "status": "A",
        "authorized_official_last_name": "CHRONISTER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "870-935-6396",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "MC-1284",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AR",
            "license": "MC-1284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116840002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CT1713",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI MEDICAID",
            "identifier": "503329807",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; 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.