Provider Demographics
NPI:1548608383
Name:COASTAL VISION CARE, PC
Entity Type:Organization
Organization Name:COASTAL VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-758-3433
Mailing Address - Street 1:2501 W WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-5916
Mailing Address - Country:US
Mailing Address - Phone:361-758-3433
Mailing Address - Fax:361-758-3424
Practice Address - Street 1:2501 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-5916
Practice Address - Country:US
Practice Address - Phone:361-758-3433
Practice Address - Fax:361-758-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6902TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132749Medicare PIN