Provider Demographics
NPI:1053305821
Name:EYE EXPRESS, INC.
Entity Type:Organization
Organization Name:EYE EXPRESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-299-8908
Mailing Address - Street 1:215 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4537
Mailing Address - Country:US
Mailing Address - Phone:863-299-8908
Mailing Address - Fax:863-299-1061
Practice Address - Street 1:5528 US 98 NORTH
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3104
Practice Address - Country:US
Practice Address - Phone:863-853-2020
Practice Address - Fax:863-527-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0596790005Medicare ID - Type Unspecified