MEDICARE: EYEMART EXPRESS, LTD.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1346383668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS, LTD.

Provider Business Mailing Address
First Line	:	2110 HUTTON DR
Second Line	:	SUITE 100
City	:	CARROLLTON
State	:	TX
Zip	:	75006-6800
Country	:	US
Telephone Number	:	972-488-2002
Fax Number	:	972-488-8563

Provider Business Practice Location Address
First Line	:	4206 KEMP BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2845
Country	:	US
Telephone Number	:	940-691-2020
Fax Number	:	940-691-2044

Authorized Official
Title or Position	:	CHIEF ADMINISTRARIVE OFFICER
Name	:	MARY JO SAMUELSON
Credential	:
Telephone Number	:	972-488-2002

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	03/18/2008

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Directions to “EYEMART EXPRESS, LTD. ” Practice Location

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