Provider Demographics
NPI:1841425998
Name:EYEMART EXPRESS, LTD
Entity Type:Organization
Organization Name:EYEMART EXPRESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:2515 N PROSPECT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1226
Mailing Address - Country:US
Mailing Address - Phone:217-355-0354
Mailing Address - Fax:217-355-0722
Practice Address - Street 1:2515 N PROSPECT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1226
Practice Address - Country:US
Practice Address - Phone:217-355-0354
Practice Address - Fax:217-355-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies