Provider Demographics
NPI:1316081680
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:MS
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 1:2110 HUTTON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6800
Mailing Address - Country:US
Mailing Address - Phone:972-488-2002
Mailing Address - Fax:972-488-8563
Practice Address - Street 1:15218A CROSSROADS PARKWAY
Practice Address - Street 2:CROSSROADS CENTER
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3564
Practice Address - Country:US
Practice Address - Phone:228-982-8808
Practice Address - Fax:228-832-8208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEMART EXPRESS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-19
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies