Provider Demographics
NPI:1134422686
Name:EYEMART EXPRESS LTD
Entity type:Organization
Organization Name:EYEMART EXPRESS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTPR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:3427 FREEDOM DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704
Mailing Address - Country:US
Mailing Address - Phone:217-718-3480
Mailing Address - Fax:217-718-3484
Practice Address - Street 1:3427 FREEDOM DRIVE
Practice Address - Street 2:
Practice Address - City:SPINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-718-3480
Practice Address - Fax:217-718-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
11292010OtherAPPLICATION DATE