# COASTAL EYE MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760979066
- **Authorized official:** RYAN SHAKE O.D. (DOCTOR)
- **Authorized official phone:** (843) 357-2020

## Contact information

- **Practice address:** 12060 HIGHWAY 17 BYP UNIT B, MURRELLS INLET, SC 29576-9401
- **Practice address phone:** (843) 357-2020
- **Mailing address:** 1255 LINKS RD, MYRTLE BEACH, SC 29575-5810
- **Mailing address phone:** (843) 357-2020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 1934 | SC | Yes |

## Other

- **Enumeration date:** 04/23/2018
- **Last updated:** 06/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1457707911 | — | SC |