Provider Demographics
NPI:1548830011
Name:COASTAL EYE ASSOCIATES
Entity type:Organization
Organization Name:COASTAL EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-360-3966
Mailing Address - Street 1:9410 COVE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5002
Mailing Address - Country:US
Mailing Address - Phone:740-360-3966
Mailing Address - Fax:
Practice Address - Street 1:1512 COASTAL GRAND CIR # C-330
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9779
Practice Address - Country:US
Practice Address - Phone:843-444-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty