Healthcare Provider Details

I. General information

NPI: 1265659403
Provider Name (Legal Business Name): COASTAL EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SE HOSPITAL AVE
STUART FL
34994-2338
US

IV. Provider business mailing address

304 SE HOSPITAL AVE
STUART FL
34994-2338
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-8444
  • Fax: 772-283-8456
Mailing address:
  • Phone: 772-283-8444
  • Fax: 772-283-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME54986
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL D PARE'
Title or Position: OWNER
Credential: MD
Phone: 772-283-8444