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General NPI Number Information
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NPI Number | 1275957797
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Entity Type | Organization
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Legal Business Name | EYEMART EXPRESS LTD
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 1345 WESTERN BLVD SUITE120
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6663
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Country | US
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Telephone | 910-376-8225
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Fax | 910-376-8232
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Provider Business Mailing Address
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Address Line | 1345 WESTERN BLVD SUITE120
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6663
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Country | US
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Telephone | 910-376-8225
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Fax | 910-376-8232
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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 | 920-997-1583
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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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