Healthcare Provider Details

I. General information

NPI: 1669622163
Provider Name (Legal Business Name): EYE-MERGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILTON RD STE 100
MYRTLE BEACH SC
29572-6623
US

IV. Provider business mailing address

350 HILTON RD STE 100
MYRTLE BEACH SC
29572-6623
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1106
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHANIEL TUNIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-762-4440