Healthcare Provider Details

I. General information

NPI: 1033041090
Provider Name (Legal Business Name): EYEMART EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 OCEAN BEACH HWY
LONGVIEW WA
98632-4341
US

IV. Provider business mailing address

3061 OCEAN BEACH HWY
LONGVIEW WA
98632-4341
US

V. Phone/Fax

Practice location:
  • Phone: 360-644-1983
  • Fax: 360-644-5212
Mailing address:
  • Phone: 360-644-1983
  • Fax: 360-644-5212

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