Organization
RETINA OF COASTAL CAROLINA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IGOR WESTRA MD (MANAGING PARTNER)
(910) 254-2023
Entity
Organization
Contact information
Practice address
1801 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5351
(910) 254-2023
(910) 254-0242
Mailing address
1801 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5351
(910) 254-2023
(910) 254-0242
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
207WX0108X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01315
BCBS OF NORTH CAROLINA
NC
05
—
790129C
—
NC
05
—
QPA675
—
SC
Enumeration date
06/09/2006
Last updated
01/10/2023
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