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	:	1235801937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LLC

Provider Business Mailing Address
First Line	:	6001 WINTER HAVEN DR NW STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1746
Country	:	US
Telephone Number	:	505-355-1841
Fax Number	:	505-355-1849

Provider Business Practice Location Address
First Line	:	6001 WINTER HAVEN DR NW STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1746
Country	:	US
Telephone Number	:	505-355-1841
Fax Number	:	505-355-1849

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	RIMMA LUSKIN
Credential	:
Telephone Number	:	212-729-5300

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	11/04/2021

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Directions to “EYEMART EXPRESS LLC ” Practice Location

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