Provider Demographics
NPI:1164601878
Name:DARREN L THORSEN OD
Entity Type:Organization
Organization Name:DARREN L THORSEN OD
Other - Org Name:COASTAL EYE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:THORSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-484-3417
Mailing Address - Street 1:819 S HOLLADAY DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6608
Mailing Address - Country:US
Mailing Address - Phone:503-738-5361
Mailing Address - Fax:503-738-9094
Practice Address - Street 1:819 S HOLLADAY DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6608
Practice Address - Country:US
Practice Address - Phone:503-738-5361
Practice Address - Fax:503-738-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2483T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226831Medicaid
ORDD2653OtherRAILROAD MEDICARE
OR226831Medicaid
OR1273470002Medicare NSC