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General NPI Number Information
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NPI Number | 1326408352
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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 | 03/03/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 5501 CAPITAL BLVD SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27616-2931
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Country | US
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Telephone | 919-651-4964
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Fax | 919-790-6863
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Provider Business Mailing Address
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Address Line | 5501 CAPITAL BLVD SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27616-2931
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Country | US
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Telephone | 919-651-4964
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Fax | 919-790-6863
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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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