Provider Demographics
NPI:1053935882
Name:EYEMART EXPRESS LLC
Entity type:Organization
Organization Name:EYEMART EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-729-5300
Mailing Address - Street 1:15 S RIVER RD # 150
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2106
Mailing Address - Country:US
Mailing Address - Phone:435-563-2560
Mailing Address - Fax:
Practice Address - Street 1:15 S RIVER RD # 150
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2106
Practice Address - Country:US
Practice Address - Phone:435-563-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier