Provider Demographics
NPI:1942343686
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:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:2600 W COLLEGE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-4200
Mailing Address - Country:US
Mailing Address - Phone:920-735-9580
Mailing Address - Fax:
Practice Address - Street 1:2600 W COLLEGE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4200
Practice Address - Country:US
Practice Address - Phone:920-735-9580
Practice Address - Fax:920-735-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0342190004Medicare NSC