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General NPI Number Information
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NPI Number | 1689181083
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Entity Type | Organization
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Legal Business Name | COASTAL EYE SURGEONS LLC
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Dates
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Enumeration Date | 01/07/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 600 W PUTNAM AVE LOWR LEVEL
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City | GREENWICH
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State | CT
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Zip | 06830
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Country | US
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Telephone | 203-900-7911
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W PUTNAM AVE LOWR LEVEL
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City | GREENWICH
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State | CT
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Zip | 06830-6080
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Country | US
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Telephone | 321-960-2664
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Fax | 877-991-2624
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. OMAR SHAKIR
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Credential | MD MBA
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Telephone | 321-960-2664
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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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