Provider Demographics
NPI:1013921121
Name:COASTAL EYE CLINIC, PA
Entity type:Organization
Organization Name:COASTAL EYE CLINIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-633-4183
Mailing Address - Street 1:802 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5236
Mailing Address - Country:US
Mailing Address - Phone:252-637-6543
Mailing Address - Fax:252-637-9580
Practice Address - Street 1:802 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5236
Practice Address - Country:US
Practice Address - Phone:252-637-6543
Practice Address - Fax:252-637-9580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL EYE CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC682156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802158Medicaid
NC8802158Medicaid