MEDICARE: DR. JAMES MICHAEL SHADE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1343	NC

General Provider Information

NPI Number	:	1740263540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL SHADE OD

Provider Business Mailing Address
First Line	:	1318 MEBANE OAKS RD
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-9681
Country	:	US
Telephone Number	:	919-304-9000
Fax Number	:	919-304-9009

Provider Business Practice Location Address
First Line	:	1318 MEBANE OAKS RD
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-9681
Country	:	US
Telephone Number	:	919-304-9000
Fax Number	:	919-304-9009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	03/07/2023

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