Provider Demographics
NPI:1588036479
Name:EYEMART EXPRESS LLC
Entity Type:Organization
Organization Name:EYEMART EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-660-1993
Mailing Address - Street 1:600 JEFFERSON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3230
Mailing Address - Country:US
Mailing Address - Phone:585-358-4117
Mailing Address - Fax:972-277-3176
Practice Address - Street 1:600 JEFFERSON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3230
Practice Address - Country:US
Practice Address - Phone:585-358-4117
Practice Address - Fax:972-277-3176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier