Provider Demographics
NPI:1255512455
Name:COAST EYECARE, PLLC
Entity type:Organization
Organization Name:COAST EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENIGNO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:228-452-0830
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-0687
Mailing Address - Country:US
Mailing Address - Phone:228-452-0830
Mailing Address - Fax:228-452-0870
Practice Address - Street 1:205 E SECOND ST
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4422
Practice Address - Country:US
Practice Address - Phone:228-452-0830
Practice Address - Fax:228-452-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1206060001Medicare NSC
CO2301Medicare PIN