Provider Demographics
NPI:1447569553
Name:EYEMART EXPRESS LTD
Entity Type:Organization
Organization Name:EYEMART EXPRESS LTD
Other - Org Name:EYEMART EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR 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 1:3732 CREEKSHIRE COURT
Mailing Address - Street 2:
Mailing Address - City:WINSTON - SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:919-902-3741
Mailing Address - Fax:
Practice Address - Street 1:3732 CREEKSHIRE COURT
Practice Address - Street 2:
Practice Address - City:WINSTON - SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:919-902-3741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HD BARNES MANGEMENT CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
9302010OtherAPPLICATION DATE