NPIMap

Organization Active NPI

Coastal Eye Group, P.C..

  • Optometrist
  • Lake City, SC
National Provider Identifier
1205145455
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
495 Issued in SC
Legal business name
COASTAL EYE GROUP, P.C..
Practice address
123 Epps St
Lake City, SC 29560-2449
Phone
(843) 374-5487
Fax
(843) 374-7342
NPI assigned
Oct 5, 2010
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
COASTAL EYE GROUP, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Dr. Frank Keenan Sloan Jr., M.D.NPI 1831119262
Title
President
Phone
(843) 449-7115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 495 SC Primary

Addresses

Primary practice location

123 Epps St
Lake City, SC 29560-2449

Mailing address

123 Epps St
Lake City, SC 29560-2449
Phone (843) 374-5487

Other identifiers 2

IdentifierTypeStateIssuer
0281OtherSCMC PTAN
D04957MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041210000633 SC Part B Supplier - Clinic/Group Practice 2466434717 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, SC; Lake City, SC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Coastal Eye Group PC6 organizations share this tax ID, including this one
Part of
Coastal Eye Group PC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1205145455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 EPPS ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602449",
            "telephone_number": "843-374-5487",
            "fax_number": "843-374-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 EPPS ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602449",
            "telephone_number": "843-374-5487",
            "fax_number": "843-374-7342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL EYE GROUP, P.C..",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL EYE GROUP, P.C.",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "SLOAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "KEENAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-449-7115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC PTAN",
            "identifier": "0281",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D04957",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.