SOUTHEASTERN RETINA ASSOCIATES P.C. NPI 1104097310

NPI Information

  • NPI: 1104097310
  • Provider Name: SOUTHEASTERN RETINA ASSOCIATES, P.C.
  • Classification: Ophthalmology - 207WX0107X
  • Specialization: Retina Specialist
  • Entity Type: Organization
  • Address: 1961 NORTHPOINT BLVD STE 110
    HIXSON, TN
    ZIP 37343
  • Phone: (423) 756-1002

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NPI Details

SOUTHEASTERN RETINA ASSOCIATES, P.C. is a retina specialist ophthalmology in Hixson, TN. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. SOUTHEASTERN RETINA ASSOCIATES, P.C. NPI is 1104097310. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1961 NORTHPOINT BLVD STE 110
HIXSON, TN
ZIP 37343-556
Phone: (423) 756-1002

The provider's authorized official is Andrew Laverghetta .
The authorized official title is Ceo and has the following contact phone number (865) 474-7596.

The enumeration date for this NPI number is 3/14/2008 and was last updated on 11/4/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207W00000XOphthalmologyNo
2207WX0107XOphthalmologyRetina SpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13715425MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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