MEDICARE: EYEMART EXPRESS LLC

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	:	1093113078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LLC

Provider Business Mailing Address
First Line	:	2515 N PROSPECT AVE
Second Line	:	STE 100
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1226
Country	:	US
Telephone Number	:	217-355-0354
Fax Number	:	217-355-0722

Provider Business Practice Location Address
First Line	:	2515 N PROSPECT AVE
Second Line	:	STE 100
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1226
Country	:	US
Telephone Number	:	217-355-0354
Fax Number	:	217-355-0722

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SKYE SEYFFARTH
Credential	:
Telephone Number	:	631-294-2329

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	03/20/2026

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Directions to “EYEMART EXPRESS LLC ” Practice Location

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