Provider Demographics
NPI:1285151985
Name:EYECARE EXPRESS
Entity type:Organization
Organization Name:EYECARE EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR TECH/OPTICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAWNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-482-2020
Mailing Address - Street 1:205 COUNTY ROAD 6 E STE P
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5583
Mailing Address - Country:US
Mailing Address - Phone:574-264-2021
Mailing Address - Fax:
Practice Address - Street 1:205 COUNTY ROAD 6 E STE P
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5583
Practice Address - Country:US
Practice Address - Phone:574-264-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE EXPRESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty