Provider Demographics
NPI:1427157387
Name:EYEWEAR EXPRESS LTD., INC
Entity type:Organization
Organization Name:EYEWEAR EXPRESS LTD., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-252-1050
Mailing Address - Street 1:229 MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7114
Mailing Address - Country:US
Mailing Address - Phone:304-252-1050
Mailing Address - Fax:
Practice Address - Street 1:229 MARKET RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7114
Practice Address - Country:US
Practice Address - Phone:304-252-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0151272000Medicaid
WV0151272000Medicaid