Provider Demographics
NPI:1962404111
Name:COASTAL VISION CENTER
Entity type:Organization
Organization Name:COASTAL VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREAS
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-650-2400
Mailing Address - Street 1:PO BOX 15790
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-5790
Mailing Address - Country:US
Mailing Address - Phone:843-650-2400
Mailing Address - Fax:843-650-2525
Practice Address - Street 1:1651 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-2400
Practice Address - Fax:843-650-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE4961OtherRR MEDICARE
SCDA9945Medicaid
SCDE4961OtherRR MEDICARE
SCDA9945Medicaid