Provider Demographics
NPI:1891839254
Name:EYEMART EXPRESS, LTD.
Entity Type:Organization
Organization Name:EYEMART EXPRESS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
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 1:2110 HUTTON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6800
Mailing Address - Country:US
Mailing Address - Phone:972-488-2002
Mailing Address - Fax:972-488-8563
Practice Address - Street 1:501 N MAIN ST
Practice Address - Street 2:SPACE #36A-ARROWHEAD MALL
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6348
Practice Address - Country:US
Practice Address - Phone:918-686-7788
Practice Address - Fax:918-686-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0342190047Medicare NSC