Organization
MIDLANDS EYE ASSOCIATES, LLC
Active
Parent organization
COASTAL GRAND EYE ASSOCIATES LTD. CO.
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTAL GRAND EYE ASSOCIATES LTD. CO.
Authorized official
DR. LAWRENCE RAYMOND CUSTER O.D. (MANAGING OPTOMETRIST)
(843) 424-2553
Entity
Organization
Contact information
Practice address
470 TOWN CENTER PL STE 5, COLUMBIA, SC 29229-7957
(843) 424-2553
Mailing address
268 SHOREWARD DR, MYRTLE BEACH, SC 29579-5146
(843) 424-2553
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
1237
SC
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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