Provider Demographics
NPI:1659602266
Name:EYEMART EXPRESS
Entity Type:Organization
Organization Name:EYEMART EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MS
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 1:6483 S . WESTNEDGE AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3542
Mailing Address - Country:US
Mailing Address - Phone:269-324-4200
Mailing Address - Fax:269-324-4202
Practice Address - Street 1:6483 S . WESTNEDGE AVE.
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3542
Practice Address - Country:US
Practice Address - Phone:269-324-4200
Practice Address - Fax:269-324-4202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HD BARNES MANAGEMENT, CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier