Provider Demographics
NPI:1699799262
Name:COASTAL EYE CLINIC PA
Entity type:Organization
Organization Name:COASTAL EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-633-4183
Mailing Address - Street 1:802 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5236
Mailing Address - Country:US
Mailing Address - Phone:252-633-4183
Mailing Address - Fax:252-636-1674
Practice Address - Street 1:3504 BRIDGES ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2912
Practice Address - Country:US
Practice Address - Phone:252-726-1064
Practice Address - Fax:252-240-0562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL EYE CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2061152W00000X
207W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914883Medicaid
NC8901354Medicaid
NC230095AMedicare ID - Type Unspecified