Provider Demographics
NPI:1740263540
Name:SHADE, JAMES MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:SHADE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1318 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9681
Mailing Address - Country:US
Mailing Address - Phone:919-304-9000
Mailing Address - Fax:919-304-9009
Practice Address - Street 1:1318 MEBANE OAKS RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9681
Practice Address - Country:US
Practice Address - Phone:919-304-9000
Practice Address - Fax:919-304-9009
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMS0105684OtherDEA NUMBER
U05726Medicare UPIN