Organization
COASTAL GRAND EYE ASSOCIATES LTD. CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE RAYMOND CUSTER OD (MEMBER)
(843) 424-2553
Entity
Organization
Contact information
Practice address
1512 COASTAL GRAND CIRCLE, C 330, MYRTLE BEACH, SC 29577-9779
(843) 444-0090
(843) 444-0377
Mailing address
PO BOX 50864, MYRTLE BEACH, SC 29579-0015
(843) 444-0090
(843) 444-0377
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1237
SC
Other
Enumeration date
02/19/2007
Last updated
02/27/2008
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