MEDICARE: EAST COAST OPTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	0000844	FL

General Provider Information

NPI Number	:	1578618799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST OPTICS, INC.

Provider Business Mailing Address
First Line	:	777 E MERRITT ISLAND CSWY
Second Line	:	#200 A
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3576
Country	:	US
Telephone Number	:	321-452-2540
Fax Number	:	321-452-7345

Provider Business Practice Location Address
First Line	:	777 E MERRITT ISLAND CSWY
Second Line	:	#200 A
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3576
Country	:	US
Telephone Number	:	321-452-2540
Fax Number	:	321-452-7345

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. OSWALD NEELY CARNATHAN
Credential	:	L.D.O.
Telephone Number	:	321-452-2540

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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Directions to “EAST COAST OPTICS, INC. ” Practice Location

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