MEDICARE: EYEMART EXPRESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1144628074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LLC

Provider Business Mailing Address
First Line	:	3450 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5327
Country	:	US
Telephone Number	:	505-326-7800
Fax Number	:	505-326-7800

Provider Business Practice Location Address
First Line	:	3450 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5327
Country	:	US
Telephone Number	:	505-326-7800
Fax Number	:	505-326-7800

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	KAREN PITTMAN
Credential	:
Telephone Number	:	972-488-2002

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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Directions to “EYEMART EXPRESS LLC ” Practice Location

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