Coastal Vision Medical Group, Inc. – Specialist, NPI 1124131065
Specialist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Coastal Vision Medical Group, Inc.
East Anaheim Street, Long Beach, Los Angeles County, California, 90804, United States
LONG BEACH, CA 908133507
Phone: (562) 591-7700
Fax: (562) 591-1311
Type: Mailing
14726 Ramona Ave Ste 290
Chino, CA 917105730
Phone: (714) 771-1213
Fax: (714) 771-7126
Type: Location
293 S Main St Ste 100
Orange, CA 928683843
Phone: (714) 771-1213
Fax: (714) 771-1213
Type: Location
15825 Laguna Canyon Rd Ste 201
Irvine, CA 926182127
Phone: (949) 453-4661
Fax: (714) 771-7126
Type: Location
360 San Miguel Dr Ste 307
Newport Beach, CA 926607829
Phone: (714) 771-1213
Fax: (714) 771-7126
Type: Location
4300 LONG BEACH BLVD STE 400
LONG BEACH, CA 908072008
Phone: (562) 591-7700
Fax: (562) 591-1311
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-09-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050923000971 | O | Clinic/Group Practice | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 90813)
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Reviews
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