# SOUTHERN EYE INSTITUTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Kellum Eye Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912980566
- **Authorized official:** ANDREA J KIEFER (OFFICE MANAGER)
- **Authorized official phone:** (985) 872-5577

## Contact information

- **Practice address:** 446 CORPORATE DR, HOUMA, LA 70360
- **Practice address phone:** (985) 872-5577
- **Practice address fax:** (985) 868-4190
- **Mailing address:** 446 CORPORATE DR, HOUMA, LA 70360
- **Mailing address phone:** (985) 872-5577
- **Mailing address fax:** (985) 868-4190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1412-554T | LA | — |
| 207W00000X | Ophthalmology Physician | 011081 | LA | — |
| 207W00000X | Ophthalmology Physician | 022479 | LA | Yes |

## Other

- **Enumeration date:** 11/28/2005
- **Last updated:** 02/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1799718 | — | LA |