NPIMap

Organization Active NPI

Coastal Optical, Inc.

  • Eyewear Supplier
  • Wilmington, NC
National Provider Identifier
1780892331
Registry record updated Feb 13, 2008
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Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
COASTAL OPTICAL, INC.
Practice address
1120 Medical Center Dr
Wilmington, NC 28401-7305
Phone
(910) 763-7316
Fax
(910) 343-6996
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Authorized official

Name
Mr. Ian T Radford, LDO
Title
Manager
Phone
(910) 763-2532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NC Primary

Addresses

Primary practice location

1120 Medical Center Dr
Wilmington, NC 28401-7305

Mailing address

1120 Medical Center Dr
Wilmington, NC 28401-7305
Phone (910) 763-7316

Other identifiers 1

IdentifierTypeStateIssuer
8801761MedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1780892331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017305",
            "telephone_number": "910-763-7316",
            "fax_number": "910-343-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017305",
            "telephone_number": "910-763-7316",
            "fax_number": "910-343-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "RADFORD",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-763-2532",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8801761",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.