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General NPI Number Information
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NPI Number | 1891873139
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Entity Type | Organization
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Legal Business Name | COASTAL EYE SPECIALISTS MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1700 N ROSE AVE SUITE 200
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City | OXNARD
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State | CA
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Zip | 93030
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Country | US
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Telephone | 805-983-0700
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Fax | 805-983-7492
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Provider Business Mailing Address
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Address Line | 1700 N ROSE AVE SUITE 200
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City | OXNARD
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State | CA
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Zip | 93030
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Country | US
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Telephone | 805-983-0700
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Fax | 805-983-7492
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Authorized Official
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Title or Position | PRESIDENT
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Name | W LEE WAN
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Credential | MD
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Telephone | 805-983-0700
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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 | G50251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A92760
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | LIAOOD OPT115TPA
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License Number State | CA
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