Healthcare Provider Details

I. General information

NPI: 1336044585
Provider Name (Legal Business Name): GULF COAST EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HIGHWAY 90
BAY ST LOUIS MS
39520-3606
US

IV. Provider business mailing address

202 E RAILROAD ST
LONG BEACH MS
39560-4627
US

V. Phone/Fax

Practice location:
  • Phone: 228-868-2020
  • Fax:
Mailing address:
  • Phone: 228-868-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RICHARD CLARK
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 228-229-6875