Healthcare Provider Details

I. General information

NPI: 1760399513
Provider Name (Legal Business Name): EYEMART EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4064 ALPINE AVE NW STE D
COMSTOCK PARK MI
49321-9045
US

IV. Provider business mailing address

4064 ALPINE AVE NW STE D
COMSTOCK PARK MI
49321-9045
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-5922
  • Fax: 616-929-5925
Mailing address:
  • Phone: 616-929-5922
  • Fax: 616-929-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIM CARUSO
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 646-660-1993