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General NPI Number Information
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NPI Number | 1982185559
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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 | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 4511 N MAIN ST STE A
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City | ROSWELL
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State | NM
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Zip | 88201-0309
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Country | US
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Telephone | 575-912-1028
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 N MAIN ST STE A
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City | ROSWELL
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State | NM
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Zip | 88201-0309
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Country | US
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Telephone | 575-912-1028
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | KIM CARUSO
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Credential |
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Telephone | 212-792-8136
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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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