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Organization
SOUTHEASTERN RETINA ASSOCIATES, P.C.
Active
Organization
SOUTHEASTERN RETINA ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW LAVERGHETTA (CEO)
(865) 588-0811
Entity
Organization
Contact information
Practice address
2412 N JOHN B DENNIS HWY, KINGSPORT, TN 37660-4772
(423) 578-4364
(423) 578-4372
Mailing address
9050 EXECUTIVE PARK DR STE 202A, KNOXVILLE, TN 37923-4670
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3715424
—
TN
05
—
89011K5
—
NC
01
—
CD7808
RAILROAD MEDICARE
TN
01
—
CG2897
RAILROAD
VA
Enumeration date
03/14/2008
Last updated
10/22/2025
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