Organization
COASTAL EYE MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SHAKE O.D. (DOCTOR)
(843) 357-2020
Entity
Organization
Contact information
Practice address
12060 HIGHWAY 17 BYP UNIT B, MURRELLS INLET, SC 29576-9401
(843) 357-2020
Mailing address
1255 LINKS RD, MYRTLE BEACH, SC 29575-5810
(843) 357-2020
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1934
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457707911
—
SC
Enumeration date
04/23/2018
Last updated
06/16/2018
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