Provider Demographics
NPI:1740631274
Name:EYEMART
Entity type:Organization
Organization Name:EYEMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:POLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-940-6335
Mailing Address - Street 1:35 S LOGAN ST
Mailing Address - Street 2:APARTMENT 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1820
Mailing Address - Country:US
Mailing Address - Phone:720-940-6335
Mailing Address - Fax:
Practice Address - Street 1:7007 E 88TH AVE
Practice Address - Street 2:L-50
Practice Address - City:HENDERSON
Practice Address - State:CO
Practice Address - Zip Code:80640-8214
Practice Address - Country:US
Practice Address - Phone:720-940-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty