Healthcare Provider Details

I. General information

NPI: 1235801937
Provider Name (Legal Business Name): EYEMART EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WINTER HAVEN DR NW STE K
ALBUQUERQUE NM
87120-1746
US

IV. Provider business mailing address

6001 WINTER HAVEN DR NW STE K
ALBUQUERQUE NM
87120-1746
US

V. Phone/Fax

Practice location:
  • Phone: 505-355-1841
  • Fax: 505-355-1849
Mailing address:
  • Phone: 505-355-1841
  • Fax: 505-355-1849

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