Provider Demographics
NPI:1457416562
Name:COASTAL FAMILY EYECARE INC
Entity Type:Organization
Organization Name:COASTAL FAMILY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-292-7334
Mailing Address - Street 1:27250 PERDIDO BEACH BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-3205
Mailing Address - Country:US
Mailing Address - Phone:251-974-1233
Mailing Address - Fax:844-965-9875
Practice Address - Street 1:27250 PERDIDO BEACH BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3205
Practice Address - Country:US
Practice Address - Phone:251-974-1233
Practice Address - Fax:844-965-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3600152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68187OtherBCBS
FL68187OtherBCBS
FL68187OtherBCBS