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General NPI Number Information
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NPI Number | 1417356494
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Entity Type | Organization
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Legal Business Name | COASTAL EYE ASSOCIATES
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 1900 NORTH LOOP W STE 360
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City | HOUSTON
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State | TX
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Zip | 77018-8100
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Country | US
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Telephone | 281-488-7213
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Fax | 713-290-0609
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Provider Business Mailing Address
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Address Line | 555 E MEDICAL CENTER BLVD STE 101
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City | WEBSTER
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State | TX
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Zip | 77598-4367
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Country | US
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Telephone | 281-488-7213
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Fax | 281-488-1387
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MR. KELLY FERREE
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Credential |
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Telephone | 281-282-5160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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