SOUTHEASTERN RETINA ASSOCIATES P.C. NPI 1932370145

NPI Information

  • NPI: 1932370145
  • Provider Name: SOUTHEASTERN RETINA ASSOCIATES, P.C.
  • Classification: Ophthalmology - 207WX0107X
  • Specialization: Retina Specialist
  • Entity Type: Organization
  • CLIA Number: 49D2321393
  • Address: 2412 N JOHN B DENNIS HWY
    KINGSPORT, TN
    ZIP 37660
  • Phone: (423) 578-4364

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NPI Details

SOUTHEASTERN RETINA ASSOCIATES, P.C. is a retina specialist ophthalmology in Kingsport, TN. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. SOUTHEASTERN RETINA ASSOCIATES, P.C. NPI is 1932370145. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2412 N JOHN B DENNIS HWY
KINGSPORT, TN
ZIP 37660-772
Phone: (423) 578-4364
Fax: (423) 578-4372

The provider's authorized official is Andrew Laverghetta .
The authorized official title is Ceo and has the following contact phone number (865) 588-0811.

The CLIA number assigned to this NPI record is 49D2321393 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2008 and was last updated on 10/22/2025.

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
13715424MEDICAIDTENNESSEE
2CD7808OTHERTENNESSEERAILROAD MEDICARE
389011K5MEDICAIDNORTH CAROLINA
4CG2897OTHERVIRGINIARAILROAD

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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