Provider Demographics
NPI:1053717926
Name:EYEMART EXPRESS LTD
Entity type:Organization
Organization Name:EYEMART EXPRESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:10136 TWO NOTCH RD
Mailing Address - Street 2:SUITE 107D
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4389
Mailing Address - Country:US
Mailing Address - Phone:803-477-3105
Mailing Address - Fax:972-277-3176
Practice Address - Street 1:10136 TWO NOTCH RD
Practice Address - Street 2:SUITE 107D
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-4389
Practice Address - Country:US
Practice Address - Phone:803-477-3105
Practice Address - Fax:972-277-3176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier