Provider Demographics
NPI:1992984470
Name:SPECIALTY EYE CARE OF THE CAROLINAS, PC
Entity type:Organization
Organization Name:SPECIALTY EYE CARE OF THE CAROLINAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-6478
Mailing Address - Street 1:1115 48TH AVE N STE 121
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5420
Mailing Address - Country:US
Mailing Address - Phone:843-449-6478
Mailing Address - Fax:843-497-8571
Practice Address - Street 1:1115 48TH AVE N STE 121
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5420
Practice Address - Country:US
Practice Address - Phone:843-449-6478
Practice Address - Fax:843-497-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC170059Medicaid
SC170059Medicaid
SC7885Medicare PIN
SC170059Medicaid