Provider Demographics
NPI:1770651267
Name:EYEMART EXPRESS LTD
Entity Type:Organization
Organization Name:EYEMART EXPRESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.A.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:2150 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2225
Mailing Address - Country:US
Mailing Address - Phone:563-355-1990
Mailing Address - Fax:563-355-2620
Practice Address - Street 1:2150 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2225
Practice Address - Country:US
Practice Address - Phone:563-355-1990
Practice Address - Fax:563-355-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies