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General NPI Number Information
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NPI Number | 1144628074
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Entity Type | Organization
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Legal Business Name | EYEMART EXPRESS LLC
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 3450 E MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87402-5327
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Country | US
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Telephone | 505-326-7800
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Fax | 505-326-7800
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Provider Business Mailing Address
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Address Line | 3450 E MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87402-5327
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Country | US
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Telephone | 505-326-7800
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Fax | 505-326-7800
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE
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Name | KAREN PITTMAN
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Credential |
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Telephone | 972-488-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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