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Organization
COASTAL EYECARE TILLAMOOK LLC
Active
Organization
COASTAL EYECARE TILLAMOOK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN L THORSEN (MEMBER)
(360) 642-3214
Entity
Organization
Contact information
Practice address
102 MAIN AVE, TILLAMOOK, OR 97141-2218
(503) 374-0399
(503) 374-0374
Mailing address
819 S HOLLADAY DR, SEASIDE, OR 97138-6608
(503) 738-5361
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
NULL
Other
Enumeration date
09/27/2018
Last updated
01/11/2019
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