Provider Demographics
NPI:1831242312
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 1:2110 HUTTON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:972-488-2002
Mailing Address - Fax:972-488-8563
Practice Address - Street 1:2901 W BROADWAY
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-474-4181
Practice Address - Fax:573-474-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies