Provider Demographics
NPI:1558497396
Name:COASTAL EYEWORKS INCORPORATED
Entity Type:Organization
Organization Name:COASTAL EYEWORKS INCORPORATED
Other - Org Name:OGDEN OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-392-4000
Mailing Address - Street 1:6836 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-9723
Mailing Address - Country:US
Mailing Address - Phone:910-392-4000
Mailing Address - Fax:910-392-5390
Practice Address - Street 1:6836 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-9723
Practice Address - Country:US
Practice Address - Phone:910-392-4000
Practice Address - Fax:910-392-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC582156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherFEDERAL TAX ID NUMBER
NC0180950001Medicare ID - Type Unspecified