Healthcare Provider Details

I. General information

NPI: 1871652875
Provider Name (Legal Business Name): COASTAL EYE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 WEST CITY DRIVE
ELIZABETH CITY NC
27909-4568
US

IV. Provider business mailing address

1855 W CITY DR
ELIZABETH CITY NC
27909-9633
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-3909
  • Fax: 252-331-1213
Mailing address:
  • Phone: 252-338-3909
  • Fax: 252-331-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number125346
License Number StateNC

VIII. Authorized Official

Name: MR. PAUL M GRIFFEY
Title or Position: OWNER
Credential: MD
Phone: 252-338-3909