Healthcare Provider Details

I. General information

NPI: 1699799262
Provider Name (Legal Business Name): COASTAL EYE CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 BRIDGES ST
MOREHEAD CITY NC
28557-2912
US

IV. Provider business mailing address

802 MCCARTHY BLVD
NEW BERN NC
28562-5236
US

V. Phone/Fax

Practice location:
  • Phone: 252-726-1064
  • Fax: 252-240-0562
Mailing address:
  • Phone: 252-633-4183
  • Fax: 252-636-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2061
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAMES K. CHANCE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 252-633-4183