Organization
EYEMART EXPRESS LTD
Active
Other names
EyeMart Express #133
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN PITTMAN (DIRECTPR OF MANAGED CARE)
(972) 488-2002
Entity
Organization
Contact information
Practice address
3427 FREEDOM DRIVE, SPINGFIELD, IL 62704
(217) 718-3480
(217) 718-3484
Mailing address
3427 FREEDOM DRIVE, SPINGFIELD, IL 62704
(217) 718-3480
(217) 718-3484
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11292010
APPLICATION DATE
—
Enumeration date
12/06/2010
Last updated
12/06/2010
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