Provider Demographics
NPI:1982079018
Name:EYEMART EXPRESS LLC
Entity Type:Organization
Organization Name:EYEMART EXPRESS LLC
Other - Org Name:VISION4LESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-660-1993
Mailing Address - Street 1:1880 TAILWIND DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6276
Mailing Address - Country:US
Mailing Address - Phone:507-779-7075
Mailing Address - Fax:507-779-7048
Practice Address - Street 1:1880 TAILWIND DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6276
Practice Address - Country:US
Practice Address - Phone:507-779-7075
Practice Address - Fax:507-779-7048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier