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	:	1619375656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LLC

Provider Business Mailing Address
First Line	:	3818 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1716
Country	:	US
Telephone Number	:	210-532-5261
Fax Number	:	210-532-9113

Provider Business Practice Location Address
First Line	:	3818 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1716
Country	:	US
Telephone Number	:	210-532-5261
Fax Number	:	210-532-9113

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

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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