Provider Demographics
NPI:1154189645
Name:EXPRESS EYEWEAR
Entity type:Organization
Organization Name:EXPRESS EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSING OPTICIAN / PRACTICE MANA
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-776-4029
Mailing Address - Street 1:14707 COUNTY ROAD 496
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75706-3351
Mailing Address - Country:US
Mailing Address - Phone:903-776-4029
Mailing Address - Fax:903-865-7435
Practice Address - Street 1:2533 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7722
Practice Address - Country:US
Practice Address - Phone:903-776-4029
Practice Address - Fax:903-865-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty