Organization
SEASIDE SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA J CLARK (OFFICE MANAGER)
(912) 466-9500
Entity
Organization
Contact information
Practice address
3303B GLYNN AVE, BRUNSWICK, GA 31520-4406
(912) 466-9500
(912) 466-9922
Mailing address
3303B GLYNN AVE, BRUNSWICK, GA 31520-4406
(912) 466-9500
(912) 466-9922
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11C0001332
MEDICARE
GA
05
—
833908673A
—
GA
Enumeration date
01/02/2009
Last updated
08/04/2025
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