Provider Demographics
NPI:1497852917
Name:REDDING, MARSHALL SIMMS (MD)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:SIMMS
Last Name:REDDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MARSHALL
Other - Middle Name:SIMMS
Other - Last Name:REDDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:COASTAL EYE CENTER
Mailing Address - Street 2:1855 WEST CITY DRIVE
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-338-3909
Mailing Address - Fax:252-331-1213
Practice Address - Street 1:COASTAL EYE CENTER
Practice Address - Street 2:1855 WEST CITY DRIVE
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-338-3909
Practice Address - Fax:252-331-1213
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15165156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970745Medicaid
NCC47645Medicare UPIN
NC8970745Medicaid