MEDICARE: COASTAL EYE CARE LLC

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	152W00000X	Optometrist	S486RA041	AL

General Provider Information

NPI Number	:	1710433271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL EYE CARE LLC

Provider Business Mailing Address
First Line	:	10184 EASTERN SHORE BLVD
Second Line	:	SUITE A
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10184 EASTERN SHORE BLVD
Second Line	:	SUITE A
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5814
Country	:	US
Telephone Number	:	251-301-5650
Fax Number	:	251-621-9645

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN M GROSS
Credential	:	O.D.
Telephone Number	:	251-301-5650

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	05/14/2019

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