# COASTAL EYECARE TILLAMOOK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295210011
- **Authorized official:** DARREN L THORSEN (MEMBER)
- **Authorized official phone:** (360) 642-3214

## Contact information

- **Practice address:** 102 MAIN AVE, TILLAMOOK, OR 97141-2218
- **Practice address phone:** (503) 374-0399
- **Practice address fax:** (503) 374-0374
- **Mailing address:** 819 S HOLLADAY DR, SEASIDE, OR 97138-6608
- **Mailing address phone:** (503) 738-5361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |
| 261QS0132X | Ophthalmologic Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/27/2018
- **Last updated:** 01/11/2019