Individual
RYAN SHAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2000 COASTAL GRAND CIR, MYRTLE BEACH, SC 29577-9798
(843) 444-0900
Mailing address
2000 COASTAL GRAND CIR, MYRTLE BEACH, SC 29577-9798
(843) 444-0900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1934
SC
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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