Provider Demographics
NPI:1558793976
Name:COASTAL OPTICAL SERVICES OF WILMINGTON
Entity Type:Organization
Organization Name:COASTAL OPTICAL SERVICES OF WILMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:SOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-763-2532
Mailing Address - Street 1:1120 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7305
Mailing Address - Country:US
Mailing Address - Phone:910-763-2532
Mailing Address - Fax:910-762-1292
Practice Address - Street 1:411 N COLONY CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-9148
Practice Address - Country:US
Practice Address - Phone:910-763-2532
Practice Address - Fax:910-762-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC594332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier