# SOUTHERN EYE CENTER P.A. II

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Eye Center of Excellence
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811144348
- **Authorized official:** LYNN B MCMAHAN M.D. (PRESIDENT)
- **Authorized official phone:** (601) 705-0078

## Contact information

- **Practice address:** 1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
- **Practice address phone:** (601) 264-3937
- **Mailing address:** 1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
- **Mailing address phone:** (601) 264-3937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 010 | MS | — |

## Other

- **Enumeration date:** 08/27/2008
- **Last updated:** 08/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C02144 | MEDICARE GROUP SUBMITTER | MS |