Provider Demographics
NPI:1700084159
Name:COASTAL EYE CARE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COASTAL EYE CARE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-1112
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-644-1112
Mailing Address - Fax:949-721-9676
Practice Address - Street 1:400 NEWPORT CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1112
Practice Address - Fax:949-721-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty