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General NPI Number Information
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NPI Number | 1194877373
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Entity Type | Organization
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Legal Business Name | COASTAL VISION CENTER OD PA
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 2183 JAMES B WHITE HWY N
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City | WHITEVILLE
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State | NC
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Zip | 28472-8989
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Country | US
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Telephone | 910-641-0011
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Fax | 910-641-0083
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Provider Business Mailing Address
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Address Line | 2183 JAMES B WHITE HWY N
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City | WHITEVILLE
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State | NC
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Zip | 28472-8989
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Country | US
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Telephone | 910-641-0011
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Fax | 910-641-0083
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS RANDALL KIRBY
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Credential | OD
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Telephone | 910-641-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1548
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License Number State | NC
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