Healthcare Provider Details

I. General information

NPI: 1275566044
Provider Name (Legal Business Name): LENS MART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E. HWY 54 SUITE 104
CAMDENTON MO
65020-1314
US

IV. Provider business mailing address

PO BOX 1314
CAMDENTON MO
65020-1314
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-7899
  • Fax: 573-346-7744
Mailing address:
  • Phone: 573-346-7899
  • Fax: 573-346-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN BABBS
Title or Position: PRESIDENT
Credential:
Phone: 573-346-7899