Provider Demographics
NPI:1821142266
Name:COASTAL EYE GROUP, P.C.
Entity Type:Organization
Organization Name:COASTAL EYE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RATELIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-652-3937
Mailing Address - Street 1:4055 HWY 17 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-652-3937
Mailing Address - Fax:843-652-3939
Practice Address - Street 1:4055 HWY 17 SOUTH
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-652-3937
Practice Address - Fax:843-652-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3709Medicaid
SC7622Medicare ID - Type UnspecifiedMI MC GROUP NUMBER