Organization Active NPI

Coastal Eye Associates Inc

  • Optometrist
  • Westerly, RI
National Provider Identifier
1174601132
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
COASTAL EYE ASSOCIATES INC
Practice address
17 Wells St
Ste 101
Westerly, RI 02891-2923
Phone
(401) 348-2020
Fax
(401) 596-9348
NPI assigned
Nov 1, 2006
Last updated
Sep 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Authorized official

Name
Holly Misto, O.D.NPI 1144278821
Title
Owner
Phone
(401) 348-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X RI Primary

Addresses

Primary practice location

17 Wells St
Ste 101
Westerly, RI 02891-2923

Mailing address

17 Wells St
Ste 101
Westerly, RI 02891-2923
Phone (401) 348-2020

Other identifiers 1

IdentifierTypeStateIssuer
CE00626MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040630000000 RI Part B Supplier - Clinic/Group Practice 1254317142 Receives reassigned benefits from 5 practitioners
Practice locations: Westerly, RI
O20100930025011 RI DME Supplier - Physician - Optometrist 1254317142 Practice locations: Westerly, RI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Coastal Eye Associates Inc17 Wells St, Westerly, RI 02891-2923(401) 348-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

17 Wells St
Ste 101
Westerly, RI 02891
Phone (401) 348-2020

Practitioners & affiliated clinicians

Practitioners 5

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1174601132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WELLS ST",
            "address_2": "STE 101",
            "city": "WESTERLY",
            "state": "RI",
            "postal_code": "028912923",
            "telephone_number": "401-348-2020",
            "fax_number": "401-596-9348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WELLS ST",
            "address_2": "STE 101",
            "city": "WESTERLY",
            "state": "RI",
            "postal_code": "028912923",
            "telephone_number": "401-348-2020",
            "fax_number": "401-596-9348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL EYE ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "MISTO",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-348-2020",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CE00626",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerly, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.