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	:	1972957561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEMART EXPRESS LLC

Provider Business Mailing Address
First Line	:	5279 WHITTLESEY BLVD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3073
Country	:	US
Telephone Number	:	706-405-7099
Fax Number	:	706-324-4838

Provider Business Practice Location Address
First Line	:	5279 WHITTLESEY BLVD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3073
Country	:	US
Telephone Number	:	706-405-7099
Fax Number	:	972-277-3176

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	07/08/2016

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Directions to “EYEMART EXPRESS LLC ” Practice Location

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