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General NPI Number Information
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NPI Number | 1275945255
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Entity Type | Organization
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Legal Business Name | SAM'S WEST, INC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1050 OGDEN AVE
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City | MONTGOMERY
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State | IL
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Zip | 60538-5404
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Country | US
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Telephone | 630-449-1953
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Fax | 630-449-1954
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Provider Business Mailing Address
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Address Line | 1 CUSTOMER DR MS 0445
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City | BENTONVILLE
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State | AR
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Zip | 72716-0445
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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 | SR. DIRECTOR
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Name | KIMBERLY CANONIC
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Credential |
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Telephone | 479-371-1168
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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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