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General NPI Number Information
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NPI Number | 1205927977
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Entity Type | Organization
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Legal Business Name | SAM'S CLUB OPTICAL
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 15 MILL CREEK CIRCLE
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-748-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 702 SW 8TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72716-0235
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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 | CONTRACT COORDINATOR
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Name | TAMMY J BOYD
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Credential |
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Telephone | 479-277-1359
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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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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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