Provider Demographics
NPI:1982456794
Name:DA SHADE ROOM EYEWEAR
Entity Type:Organization
Organization Name:DA SHADE ROOM EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-182-8287
Mailing Address - Street 1:502 E 3RD ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-0002
Mailing Address - Country:US
Mailing Address - Phone:616-104-6773
Mailing Address - Fax:808-860-8211
Practice Address - Street 1:502 E 3RD ST UNIT 4
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-0002
Practice Address - Country:US
Practice Address - Phone:610-467-7377
Practice Address - Fax:800-860-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty