Provider Demographics
NPI:1982078085
Name:EYEMART EXPRESS LLC
Entity Type:Organization
Organization Name:EYEMART EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:15206 W 119TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5604
Mailing Address - Country:US
Mailing Address - Phone:913-353-8390
Mailing Address - Fax:972-277-3176
Practice Address - Street 1:15206 W 119TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5604
Practice Address - Country:US
Practice Address - Phone:913-353-8390
Practice Address - Fax:972-277-3176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier