Provider Demographics
NPI:1831958735
Name:SHADES LLC
Entity type:Organization
Organization Name:SHADES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:401-284-4591
Mailing Address - Street 1:40A PIER MARKET PL
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3389
Mailing Address - Country:US
Mailing Address - Phone:401-284-4591
Mailing Address - Fax:
Practice Address - Street 1:40A PIER MARKET PL
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3389
Practice Address - Country:US
Practice Address - Phone:401-284-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty