Provider Demographics
NPI:1093805004
Name:EYEMART EXPRESS LTD
Entity Type:Organization
Organization Name:EYEMART EXPRESS LTD
Other - Org Name:EYEWEAR EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:2110 HUTTON DR
Mailing Address - Street 2:#100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:972-488-2002
Mailing Address - Fax:972-488-8563
Practice Address - Street 1:4415 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6705
Practice Address - Country:US
Practice Address - Phone:337-406-0620
Practice Address - Fax:337-406-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0342190038Medicare ID - Type Unspecified