Provider Demographics
NPI:1659521862
Name:EYEMART EXPRESS, LTD.
Entity Type:Organization
Organization Name:EYEMART EXPRESS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MVC
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:P
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:538 EMILY DR.
Mailing Address - Street 2:SPACE 20
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:304-566-4393
Mailing Address - Fax:304-566-4396
Practice Address - Street 1:538 EMILY DR.
Practice Address - Street 2:SPACE 20
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-566-4393
Practice Address - Fax:304-566-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies