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NPI Code Detail

MEDICARE: SAM'S EAST, INC.

MEDICARE: SAM'S EAST, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1205472271
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM'S EAST, INC.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-204-1258
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 1900 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6504
Country : US
Telephone Number : 479-204-1258
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF HEALTH CARE CONTRACTING
Name : SARAH LITTLE
Credential :
Telephone Number : 479-277-2500
Provider Enumeration Date : 11/25/2019
Last Update Date : 01/09/2020

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