Healthcare Provider Details

I. General information

NPI: 1699941179
Provider Name (Legal Business Name): SHADE EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 08/10/2010
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 Code332H00000X
TaxonomyEyewear Supplier
License NumberOEG000169
License Number StatePA

VIII. Authorized Official

Name: DR. MICHELE SHADE
Title or Position: OWNER
Credential: O.D.
Phone: 610-326-1106