Provider Demographics
NPI:1477663706
Name:COASTAL EYE GROUP, P.C.
Entity Type:Organization
Organization Name:COASTAL EYE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:KEENAN
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-7115
Mailing Address - Street 1:401 79TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4310
Mailing Address - Country:US
Mailing Address - Phone:843-449-7115
Mailing Address - Fax:843-497-2960
Practice Address - Street 1:401 79TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4310
Practice Address - Country:US
Practice Address - Phone:843-449-7115
Practice Address - Fax:843-497-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890172HOtherNC MEDICAID
SCGP0321Medicaid
SC=========OtherFEDERAL TAX I.D. NUMBER
SCGP0321Medicaid