Provider Demographics
NPI:1205145455
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:KEENAN
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-7115
Mailing Address - Street 1:123 EPPS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2449
Mailing Address - Country:US
Mailing Address - Phone:843-374-5487
Mailing Address - Fax:843-374-7342
Practice Address - Street 1:123 EPPS ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2449
Practice Address - Country:US
Practice Address - Phone:843-374-5487
Practice Address - Fax:843-374-7342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL EYE GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0281OtherMC PTAN
SCD04957Medicaid
SCU21527Medicare UPIN