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General NPI Number Information
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NPI Number | 1760661235
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Entity Type | Organization
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Legal Business Name | SPECIALTY EYE CARE OF THE CAROLINAS, PC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 15 MEDICAL CENTER DR
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City | SUPPLY
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State | NC
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Zip | 28462-3350
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Country | US
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Telephone | 910-754-5437
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Fax | 910-754-5443
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Provider Business Mailing Address
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Address Line | 1115 48TH AVE N STE 121
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5420
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Country | US
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Telephone | 843-449-6478
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Fax | 843-497-8571
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAWN F. RILEY
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Credential | MD
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Telephone | 910-754-5434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 9300575
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License Number State | NC
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