Healthcare Provider Details

I. General information

NPI: 1295736445
Provider Name (Legal Business Name): SHAWN D THOMAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 INLET SQUARE DR STE B
MURRELLS INLET SC
29576-7812
US

IV. Provider business mailing address

11947 GRANDHAVEN DR STE M
MURRELLS INLET SC
29576-7862
US

V. Phone/Fax

Practice location:
  • Phone: 843-299-2485
  • Fax: 843-299-2486
Mailing address:
  • Phone: 843-299-2485
  • Fax: 843-299-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1676
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1676
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: