Provider Demographics
NPI:1114223823
Name:COAST EYES PLLC
Entity Type:Organization
Organization Name:COAST EYES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-392-8141
Mailing Address - Street 1:3887 PROMENADE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:D'IBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-5379
Mailing Address - Country:US
Mailing Address - Phone:228-392-8141
Mailing Address - Fax:228-392-8181
Practice Address - Street 1:3887 PROMENADE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:D'IBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5379
Practice Address - Country:US
Practice Address - Phone:228-392-8141
Practice Address - Fax:228-392-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty