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General NPI Number Information
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NPI Number | 1982456794
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Entity Type | Organization
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Legal Business Name | DA SHADE ROOM EYEWEAR
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 502 E 3RD ST UNIT 4
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City | TULSA
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State | OK
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Zip | 74120-0002
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Country | US
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Telephone | 610-467-7377
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Fax | 800-860-8211
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Provider Business Mailing Address
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Address Line | 502 E 3RD ST UNIT 4
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City | TULSA
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State | OK
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Zip | 74120-0002
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Country | US
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Telephone | 616-104-6773
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Fax | 808-860-8211
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Authorized Official
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Title or Position | OWNER
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Name | RENE BRAMLETT
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Credential |
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Telephone | 919-182-8287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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