Healthcare Provider Details

I. General information

NPI: 1104128917
Provider Name (Legal Business Name): COASTAL EYE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGHMARKET ST STE 101
GEORGETOWN SC
29440-3227
US

IV. Provider business mailing address

401 79TH AVE N
MYRTLE BEACH SC
29572-4310
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8421
  • Fax: 843-546-1173
Mailing address:
  • Phone: 843-449-7115
  • Fax: 843-497-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK K SLOAN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-449-7115