Healthcare Provider Details

I. General information

NPI: 1396219374
Provider Name (Legal Business Name): EYEMART EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W PLEASANT CROSSING DR STE 60
ROGERS AR
72758-8323
US

IV. Provider business mailing address

2600 W PLEASANT CROSSING DR STE 60
ROGERS AR
72758-8323
US

V. Phone/Fax

Practice location:
  • Phone: 479-202-4740
  • Fax:
Mailing address:
  • Phone: 479-202-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RIMMA LUSKIN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 212-729-5300