Healthcare Provider Details

I. General information

NPI: 1154699213
Provider Name (Legal Business Name): EYEMART EXPRESS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 E LOHMAN AVE STE F
LAS CRUCES NM
88011-8256
US

IV. Provider business mailing address

3050 E LOHMAN AVE STE F
LAS CRUCES NM
88011-8256
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-5970
  • Fax:
Mailing address:
  • Phone: 575-257-5970
  • 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: KAREN PITTMAN
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 972-488-2002