Organization
SOUTHERN EYE PHYSICIANS CENTER, LLC
Active
Other names
Southern Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIPER C NELSON M.D. (MANAGING MEMBER/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
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014315
—
MS
01
—
512G700152
MEDICARE PTAN
MS
Enumeration date
01/22/2008
Last updated
06/23/2021
Update your record
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