NPIMap

Organization Active NPI

Coastal Grand Eye Associates LTD. Co.

  • Optometrist
  • Myrtle Beach, SC
National Provider Identifier
1780728824
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
SC1237 Issued in SC
Legal business name
COASTAL GRAND EYE ASSOCIATES LTD. CO.
Practice address
1512 Coastal Grand Circle
C 330
Myrtle Beach, SC 29577-9779
Phone
(843) 444-0090
Fax
(843) 444-0377
NPI assigned
Feb 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Dr. Lawrence Raymond Custer, ODNPI 1740406214
Title
Member
Phone
(843) 424-2553

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: 193400000X SINGLE SPECIALTY GROUP 152W00000X SC1237 SC Primary

Addresses

Primary practice location

1512 Coastal Grand Circle
C 330
Myrtle Beach, SC 29577-9779

Mailing address

PO Box 50864
Myrtle Beach, SC 29579-0015
Phone (843) 444-0090

National Provider Directory

National Provider Directory

Locations

100 Columbiana Cir
#154
Columbia, SC 29212
Phone (803) 781-1669

1512 Coastal Grand Cir
#330
Myrtle Beach, SC 29577
Phone (843) 444-0090

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1780728824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50864",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295790015",
            "telephone_number": "843-444-0090",
            "fax_number": "843-444-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 COASTAL GRAND CIRCLE",
            "address_2": "C 330",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295779779",
            "telephone_number": "843-444-0090",
            "fax_number": "843-444-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL GRAND EYE ASSOCIATES LTD. CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "CUSTER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "843-424-2553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "SC1237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.