Healthcare Provider Details

I. General information

NPI: 1376878611
Provider Name (Legal Business Name): EYEMART EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5254 MONROE ST
TOLEDO OH
43623-3140
US

IV. Provider business mailing address

5254 MONROE ST
TOLEDO OH
43623-3140
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-6600
  • Fax: 419-843-6606
Mailing address:
  • Phone: 419-843-6600
  • Fax: 419-843-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARK EDWARD LOCKLEAR
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 972-488-2002