Organization
COASTAL VISION CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE ROSALIE JURAS OD (OWNER)
(843) 693-2505
Entity
Organization
Contact information
Practice address
605 SAINT JAMES AVE, GOOSE CREEK, SC 29445
(843) 863-1215
(843) 553-7335
Mailing address
PO BOX 23, ISLE OF PALMS, SC 29451
(843) 693-2505
(843) 553-7335
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC0956
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D09569
—
SC
05
—
DA9726
—
SC
Enumeration date
09/06/2006
Last updated
08/22/2020
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