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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1659509107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LTD

Provider Business Mailing Address
First Line	:	1605 EGLIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6107
Country	:	US
Telephone Number	:	605-341-3878
Fax Number	:	605-341-3919

Provider Business Practice Location Address
First Line	:	1605 EGLIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6107
Country	:	US
Telephone Number	:	605-341-3878
Fax Number	:	605-341-3919

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JONATHAN HERSKOVITZ
Credential	:
Telephone Number	:	972-488-2002

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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Directions to “EYEMART EXPRESS LTD ” Practice Location

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