Provider Demographics
NPI:1316916075
Name:SHINNERS, FREDERICK ADRIAN JR (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ADRIAN
Last Name:SHINNERS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 THEATER DR
Mailing Address - Street 2:MT, PLEASANT TOWNE CENTRE
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3398
Mailing Address - Country:US
Mailing Address - Phone:843-216-1338
Mailing Address - Fax:843-216-1487
Practice Address - Street 1:1308 THEATER DR
Practice Address - Street 2:MT, PLEASANT TOWNE CENTRE
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3398
Practice Address - Country:US
Practice Address - Phone:843-216-1338
Practice Address - Fax:843-216-1487
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7021Medicare PIN