Healthcare Provider Details

I. General information

NPI: 1073781696
Provider Name (Legal Business Name): MICHELE Y SHADE, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 SHOEMAKER RD
POTTSTOWN PA
19464-6430
US

IV. Provider business mailing address

142 SHOEMAKER RD
POTTSTOWN PA
19464-6430
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-1106
  • Fax: 610-326-1108
Mailing address:
  • Phone: 610-326-1106
  • Fax: 610-326-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000169
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOEG000169
License Number StatePA

VIII. Authorized Official

Name: DR. MICHELE SHADE
Title or Position: PROPRIETOR
Credential: OD
Phone: 610-326-1106