Provider Demographics
NPI:1821142720
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:843-546-8421
Mailing Address - Street 1:1200 HIGHMARKET ST STE 200
Mailing Address - Street 2:P.O. BOX 2900
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3227
Mailing Address - Country:US
Mailing Address - Phone:843-546-8421
Mailing Address - Fax:843-652-1173
Practice Address - Street 1:1200 HIGHMARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3227
Practice Address - Country:US
Practice Address - Phone:843-546-8421
Practice Address - Fax:843-652-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0502Medicaid
SCPC0502Medicaid