Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 17005 | SC |
N | 207W00000X | Ophthalmologist | 9300575 | NC |
NPI | 1003873894 |
---|---|
Provider Name | Dr. Shawn F Riley |
First Address | Myrtle Beach, SC 29577 |
Second Address | Myrtle Beach, SC 29577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 31/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F43253 | (02) | SC |