NPIMap

Organization Active NPI

Darren L Thorsen OD

Doing business as Coastal Eye Care LLC

  • Optometrist
  • Seaside, OR
National Provider Identifier
1164601878
Registry record updated Feb 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2483T Issued in OR
Legal business name
DARREN L THORSEN OD
Doing business as
Coastal Eye Care LLC
Practice address
819 S Holladay Dr
Seaside, OR 97138-6608
Phone
(503) 738-5361
Fax
(503) 738-9094
NPI assigned
Oct 30, 2007
Last updated
Feb 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Andrea Florence Thorsen
Title
Practice Manager
Phone
(360) 484-3417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2483T OR Primary

Addresses

Primary practice location

819 S Holladay Dr
Seaside, OR 97138-6608

Mailing address

819 S Holladay Dr
Seaside, OR 97138-6608
Phone (503) 738-5361

Other identifiers 2

IdentifierTypeStateIssuer
226831MedicaidOR
DD2653OtherORRAILROAD MEDICARE

Other names 1

  • Coastal Eye Care LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602000641 OR Part B Supplier - Clinic/Group Practice 9739161902 Receives reassigned benefits from 8 practitioners
Practice locations: Astoria, OR; Seaside, OR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1164601878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 S HOLLADAY DR",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971386608",
            "telephone_number": "503-738-5361",
            "fax_number": "503-738-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 S HOLLADAY DR",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971386608",
            "telephone_number": "503-738-5361",
            "fax_number": "503-738-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARREN L THORSEN OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "THORSEN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "FLORENCE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "360-484-3417",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2483T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226831",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD2653",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Eye Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seaside, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.