Provider Demographics
NPI:1184315566
Name:COASTAL PLAINS EYE CARE, LLC
Entity type:Organization
Organization Name:COASTAL PLAINS EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PICHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-732-1800
Mailing Address - Street 1:101 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1615
Mailing Address - Country:US
Mailing Address - Phone:912-732-1800
Mailing Address - Fax:912-732-1801
Practice Address - Street 1:101 DANIEL ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1615
Practice Address - Country:US
Practice Address - Phone:912-732-1800
Practice Address - Fax:912-732-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty