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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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