Provider Demographics
NPI:1295736445
Name:THOMAS, SHAWN D (OD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11947 GRANDHAVEN DR STE M
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7862
Mailing Address - Country:US
Mailing Address - Phone:843-299-2485
Mailing Address - Fax:843-299-2486
Practice Address - Street 1:912 INLET SQUARE DR STE B
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7812
Practice Address - Country:US
Practice Address - Phone:843-299-2485
Practice Address - Fax:843-299-2486
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1676152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100915892Medicaid
SCD16766Medicaid
PA100915892Medicaid