Organization
COASTAL OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IAN T RADFORD LDO (MANAGER)
(910) 763-2532
Entity
Organization
Contact information
Practice address
1120 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
(910) 763-7316
(910) 343-6996
Mailing address
1120 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
(910) 763-7316
(910) 343-6996
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8801761
—
NC
Enumeration date
05/18/2007
Last updated
02/13/2008
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