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
1	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1306463617
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	:

Provider Business Practice Location Address
First Line	:	5510 SW 5TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-1216
Country	:	US
Telephone Number	:	405-943-9810
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF HEALTH CARE CONTRACTING
Name	:	SARAH LITTLE
Credential	:
Telephone Number	:	479-277-2500

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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