Provider Demographics
NPI:1629476601
Name:EYEMART EXPRESS LLC
Entity Type:Organization
Organization Name:EYEMART EXPRESS LLC
Other - Org Name:
Other - Org Type:
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 1:1680 COBURG RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4869
Mailing Address - Country:US
Mailing Address - Phone:541-485-0303
Mailing Address - Fax:541-485-1173
Practice Address - Street 1:1680 COBURG RD
Practice Address - Street 2:STE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4869
Practice Address - Country:US
Practice Address - Phone:541-485-0303
Practice Address - Fax:541-485-1173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier