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General NPI Number Information
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NPI Number | 1780892331
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Entity Type | Organization
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Legal Business Name | COASTAL OPTICAL, INC.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 1120 MEDICAL CENTER DR
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City | WILMINGTON
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State | NC
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Zip | 28401-7305
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Country | US
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Telephone | 910-763-7316
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Fax | 910-343-6996
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Provider Business Mailing Address
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Address Line | 1120 MEDICAL CENTER DR
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City | WILMINGTON
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State | NC
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Zip | 28401-7305
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Country | US
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Telephone | 910-763-7316
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Fax | 910-343-6996
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Authorized Official
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Title or Position | MANAGER
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Name | MR. IAN T RADFORD
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Credential | LDO
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Telephone | 910-763-2532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | NC
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