Provider Demographics
NPI:1992083653
Name:COASTAL EYE CARE LLC
Entity type:Organization
Organization Name:COASTAL EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:THORSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-484-3417
Mailing Address - Street 1:577 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3505
Mailing Address - Country:US
Mailing Address - Phone:503-325-4401
Mailing Address - Fax:503-325-4449
Practice Address - Street 1:577 18TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3505
Practice Address - Country:US
Practice Address - Phone:503-325-4401
Practice Address - Fax:503-325-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2483AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty