Organization
EYE-MART FACTORY OUTLET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIZ ANNE WICKS (MANAGER)
(970) 241-2884
Entity
Organization
Contact information
Practice address
2139 N 12TH ST, UNIT 5, GRAND JUNCTION, CO 81501-2901
(970) 241-2020
(970) 241-7735
Mailing address
2139 N 12TH ST, UNIT 5, GRAND JUNCTION, CO 81501-2901
(970) 241-2020
(970) 241-7735
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
COTP125233A
—
CO
Enumeration date
01/03/2008
Last updated
01/03/2008
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