Provider Demographics
NPI:1538752514
Name:COASTAL EYE SURGERY CENTER PLLC
Entity type:Organization
Organization Name:COASTAL EYE SURGERY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA
Authorized Official - Phone:203-900-7911
Mailing Address - Street 1:600 W PUTNAM AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6080
Mailing Address - Country:US
Mailing Address - Phone:203-900-7911
Mailing Address - Fax:203-900-7911
Practice Address - Street 1:600 W PUTNAM AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6080
Practice Address - Country:US
Practice Address - Phone:203-900-7911
Practice Address - Fax:203-900-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery