Organization
SOUTHERN EYE SURGERY CENTER LLC
Active
Other names
Southern Eye Center of Excellence
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN B MCMAHAN M.D. (PRESIDENT)
(601) 264-3937
Entity
Organization
Contact information
Practice address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
(601) 264-5930
Mailing address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
(601) 264-5930
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
010
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770066
—
MS
01
—
512G490003
MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS
Enumeration date
01/31/2008
Last updated
01/15/2009
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