Provider Demographics
NPI:1407045958
Name:COASTAL EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:COASTAL EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-488-7213
Mailing Address - Street 1:555 E MEDICAL CENTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4367
Mailing Address - Country:US
Mailing Address - Phone:281-488-7213
Mailing Address - Fax:281-488-1387
Practice Address - Street 1:11550 FUQUA ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4599
Practice Address - Country:US
Practice Address - Phone:281-488-7213
Practice Address - Fax:281-669-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345484501Medicaid
TX45D2057002OtherCLIA
TX45D2057002OtherCLIA
TX345484501Medicaid
TX1093100006Medicare NSC