Provider Demographics
NPI:1912042011
Name:OPTICAL SHADES N SPECS, LLC
Entity Type:Organization
Organization Name:OPTICAL SHADES N SPECS, LLC
Other - Org Name:SHADES N SPECS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-334-3443
Mailing Address - Street 1:842C NM HWY 516
Mailing Address - Street 2:
Mailing Address - City:FLORA VISTA
Mailing Address - State:NM
Mailing Address - Zip Code:87415-9602
Mailing Address - Country:US
Mailing Address - Phone:505-334-3443
Mailing Address - Fax:505-334-9089
Practice Address - Street 1:842C NM HWY 516
Practice Address - Street 2:
Practice Address - City:FLORA VISTA
Practice Address - State:NM
Practice Address - Zip Code:87415-9602
Practice Address - Country:US
Practice Address - Phone:505-334-3443
Practice Address - Fax:505-334-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42257OtherDAVIS VISION
NMNM7706OtherEYEMED VISION CARE