Provider Demographics
NPI:1871637231
Name:EYEMART EXPRESS, LTD.
Entity type:Organization
Organization Name:EYEMART EXPRESS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-2002
Mailing Address - Street 1:3474 CATCLAW DR STE A
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8234
Mailing Address - Country:US
Mailing Address - Phone:325-793-9001
Mailing Address - Fax:325-695-3449
Practice Address - Street 1:3474 CATCLAW DR
Practice Address - Street 2:SUITE A-CATCLAW SHOPPING CEMTER
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8234
Practice Address - Country:US
Practice Address - Phone:325-793-9011
Practice Address - Fax:325-695-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0342190025Medicare NSC