Provider Demographics
NPI:1891010963
Name:KOOL SHADES
Entity Type:Organization
Organization Name:KOOL SHADES
Other - Org Name:IZ OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAI
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-777-5141
Mailing Address - Street 1:3319 EAST PLANTATION
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-7553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 SPENCER HWY
Practice Address - Street 2:SPACE AA-1
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-3762
Practice Address - Country:US
Practice Address - Phone:713-944-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier