Provider Demographics
NPI:1811436488
Name:SHEADE, P.C.
Entity type:Organization
Organization Name:SHEADE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-436-4223
Mailing Address - Street 1:2640 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1354
Mailing Address - Country:US
Mailing Address - Phone:847-436-4223
Mailing Address - Fax:
Practice Address - Street 1:1005 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2935
Practice Address - Country:US
Practice Address - Phone:847-998-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300325588Medicare PIN