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General NPI Number Information
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NPI Number | 1225684020
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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 | 08/16/2019
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1715 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-4705
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Country | US
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Telephone | 406-203-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-4705
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Country | US
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Telephone | 406-203-1570
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | KIM CARUSO
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Credential |
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Telephone | 646-660-1993
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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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