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General NPI Number Information
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NPI Number | 1033514690
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Entity Type | Organization
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Legal Business Name | SAM'S OPTICAL WEST LLC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 3383 N MERIDIAN AVE
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City | NEWCASTLE
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State | OK
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Zip | 73065-3634
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Country | US
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Telephone | 405-387-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 3383 N MERIDIAN AVE
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City | NEWCASTLE
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State | OK
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Zip | 73065-3634
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | SHELLY BERTIN
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Credential |
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Telephone | 405-387-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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