Healthcare Provider Details

I. General information

NPI: 1326089442
Provider Name (Legal Business Name): RETINA OF COASTAL CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5351
US

IV. Provider business mailing address

1801 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5351
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-2023
  • Fax: 910-254-0242
Mailing address:
  • Phone: 910-254-2023
  • Fax: 910-254-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY DOUGLAS HOLT
Title or Position: MD
Credential: MD
Phone: 910-254-2023