MEDICARE: EYEMART EXPRESS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1033415179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LTD

Provider Business Mailing Address
First Line	:	335 MAINE MALL RD
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3214
Country	:	US
Telephone Number	:	207-771-7962
Fax Number	:	207-771-7984

Provider Business Practice Location Address
First Line	:	335 MAINE MALL RD
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3214
Country	:	US
Telephone Number	:	207-771-7962
Fax Number	:	207-771-7984

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	MS. KAREN PITTMAN
Credential	:
Telephone Number	:	972-488-2002

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	02/14/2011

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