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General NPI Number Information
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NPI Number | 1336044585
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Entity Type | Organization
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Legal Business Name | GULF COAST EYECARE
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 299 HIGHWAY 90
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City | BAY ST LOUIS
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State | MS
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Zip | 39520-3606
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Country | US
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Telephone | 228-868-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 202 E RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4627
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Country | US
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Telephone | 228-868-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. RICHARD CLARK
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Credential | OD
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Telephone | 228-229-6875
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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 |
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License Number State | NULL
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