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General NPI Number Information
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NPI Number | 1528584562
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Entity Type | Organization
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Legal Business Name | EYECARE EXPRESS
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 700 E COLISEUM BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46805-1220
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Country | US
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Telephone | 260-482-2020
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Fax | 260-482-3333
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Provider Business Mailing Address
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Address Line | 700 E COLISEUM BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46805-1220
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Country | US
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Telephone | 260-482-2020
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Fax | 260-482-3333
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Authorized Official
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Title or Position | OPTICIAN/DOC TECH
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Name | MISS SHAWNDA B TAYLOR
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Credential |
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Telephone | 260-482-2020
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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 | 18003705
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License Number State | IN
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