Provider Demographics
NPI:1518134246
Name:NORTH COAST OPTOMETRY
Entity Type:Organization
Organization Name:NORTH COAST OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-757-8771
Mailing Address - Street 1:3915 MISSION AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7801
Mailing Address - Country:US
Mailing Address - Phone:760-757-8771
Mailing Address - Fax:760-757-3073
Practice Address - Street 1:3915 MISSION AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7801
Practice Address - Country:US
Practice Address - Phone:760-757-8771
Practice Address - Fax:760-757-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP9751Medicare PIN
CAOP8079Medicare PIN