Provider Demographics
NPI:1528584562
Name:EYECARE EXPRESS
Entity Type:Organization
Organization Name:EYECARE EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/DOC TECH
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAWNDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-482-2020
Mailing Address - Street 1:700 E COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1220
Mailing Address - Country:US
Mailing Address - Phone:260-482-2020
Mailing Address - Fax:260-482-3333
Practice Address - Street 1:700 E COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1220
Practice Address - Country:US
Practice Address - Phone:260-482-2020
Practice Address - Fax:260-482-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003705332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier