Organization
COASTAL EYE SPECIALISTS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
W LEE WAN MD (PRESIDENT)
(805) 983-0700
Entity
Organization
Contact information
Practice address
1700 N ROSE AVE, SUITE 200, OXNARD, CA 93030
(805) 983-0700
(805) 983-7492
Mailing address
1700 N ROSE AVE, SUITE 200, OXNARD, CA 93030
(805) 983-0700
(805) 983-7492
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
LIAOOD OPT115TPA
CA
207W00000X
Ophthalmology Physician
A92760
CA
207W00000X
Ophthalmology Physician
G50251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0076240
—
CA
Enumeration date
11/02/2006
Last updated
09/11/2025
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