Provider Demographics
NPI:1164507794
Name:COASTAL EYE CARE, P.A.
Entity Type:Organization
Organization Name:COASTAL EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDAENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-667-6300
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-1539
Mailing Address - Country:US
Mailing Address - Phone:207-667-6300
Mailing Address - Fax:
Practice Address - Street 1:128 BUCKSPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2239
Practice Address - Country:US
Practice Address - Phone:207-667-6300
Practice Address - Fax:207-667-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127190000Medicaid
ME127190000Medicaid