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Organization

COASTAL OPTICAL, INCORPORATED

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CAROL L. RATELIFF (OFFICE MANAGER)
(843) 449-6951
Entity
Organization

Contact information

Practice address
401 79TH AVE N, MYRTLE BEACH, SC 29572-4310
(843) 449-6951
(843) 497-2960
Mailing address
401 79TH AVE N, MYRTLE BEACH, SC 29572-4310
(843) 449-6951
(843) 497-2960

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0851690001
MC PIN NUMBER
SC
Enumeration date
01/23/2007
Last updated
05/04/2009
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