Healthcare Provider Details

I. General information

NPI: 1174601132
Provider Name (Legal Business Name): COASTAL EYE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WELLS ST STE 101
WESTERLY RI
02891-2923
US

IV. Provider business mailing address

17 WELLS ST STE 101
WESTERLY RI
02891-2923
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-2020
  • Fax: 401-596-9348
Mailing address:
  • Phone: 401-348-2020
  • Fax: 401-596-9348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOLLY MISTO
Title or Position: OWNER
Credential: O.D.
Phone: 401-348-2020