Provider Demographics
NPI:1205857562
Name:COASTAL BEND EYE CENTER
Entity Type:Organization
Organization Name:COASTAL BEND EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-888-4288
Mailing Address - Street 1:900 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2028
Mailing Address - Country:US
Mailing Address - Phone:361-888-4288
Mailing Address - Fax:361-888-4786
Practice Address - Street 1:900 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2028
Practice Address - Country:US
Practice Address - Phone:361-888-4288
Practice Address - Fax:361-888-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E25YOtherBLUE CROSS/BLUE SHIELD
TXCS3829OtherMEDICARE-RAILROAD
TXCS3829OtherMEDICARE-RAILROAD