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General NPI Number Information
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NPI Number | 1174901326
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Entity Type | Organization
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Legal Business Name | EYEMART INC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 104 E MAIN ST
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City | STREATOR
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State | IL
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Zip | 61364-2901
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Country | US
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Telephone | 815-672-1161
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Fax | 815-672-7581
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Provider Business Mailing Address
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Address Line | 104 E MAIN ST
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City | STREATOR
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State | IL
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Zip | 61364-2901
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Country | US
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Telephone | 815-672-1161
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Fax | 815-672-7581
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Authorized Official
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Title or Position | OWNER
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Name | GAYLE ACKERMAN
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Credential |
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Telephone | 815-672-1161
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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 | 1013061795
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License Number State | IL
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