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General NPI Number Information
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NPI Number | 1700929460
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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 | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2811 S ONEIDA ST
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City | ASHWAUBENON
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State | WI
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Zip | 54304-5748
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Country | US
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Telephone | 920-496-0012
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Fax | 920-496-0256
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Provider Business Mailing Address
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Address Line | 2110 HUTTON DR SUITE 100
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City | CARROLLTON
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State | TX
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Zip | 75006-6800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRARIVE OFFICER
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Name | MARY JO SAMUELSON
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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