Provider Demographics
NPI:1568766020
Name:EYE EXPRESS, INC.
Entity Type:Organization
Organization Name:EYE EXPRESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
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:SUITE 100
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:863-595-2838
Practice Address - Street 1:500 E CENTRAL AVE
Practice Address - Street 2:OPTICAL SUITE
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3053
Practice Address - Country:US
Practice Address - Phone:863-299-8908
Practice Address - Fax:863-595-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC931332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE DME
FLPENDINGMedicaid