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General NPI Number Information
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NPI Number | 1629542600
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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 | 01/14/2019
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 4542 ELKHART RD STE 100
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City | ELKHART
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State | IN
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Zip | 46517-3572
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Country | US
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Telephone | 574-538-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 4542 ELKHART RD STE 100
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City | ELKHART
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State | IN
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Zip | 46517-3572
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Country | US
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Telephone | 574-538-4236
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | RIMMA LUSKIN
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Credential |
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Telephone | 212-729-5300
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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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