| Coastal Eye Management Llc | |
|
12060 Highway 17 Byp Unit B Murrells Inlet SC 29576-9401 | |
| (843) 357-2020 | |
| Not Available |
| Full Name | Coastal Eye Management Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12060 Highway 17 Byp Unit B, Murrells Inlet, South Carolina |
| Authorized Official Name and Position | Ryan Shake (DOCTOR) |
| Authorized Official Contact | 8433572020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Eye Management Llc 1255 Links Rd Myrtle Beach SC 29575-5810 Ph: (843) 357-2020 | Coastal Eye Management Llc 12060 Highway 17 Byp Unit B Murrells Inlet SC 29576-9401 Ph: (843) 357-2020 |
| NPI Number | 1760979066 |
|---|---|
| Provider Enumeration Date | 04/23/2018 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 2365797461 |
|---|---|
| Medicare Enrollment ID | O20180613001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760979066 | NPI | - | NPPES |
| 1457707911 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1934 (South Carolina) | Primary |
| Provider Name | Ryan R Shake |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457707911 PECOS PAC ID: 5698061596 Enrollment ID: I20160831003084 |
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