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General NPI Number Information
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NPI Number | 1669350781
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Entity Type | Organization
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Legal Business Name | SAM'S EAST, INC.
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 600 WILLARD HAGAN DR
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City | LEBANON
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State | TN
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Zip | 37090
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Country | US
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Telephone | 615-994-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CUSTOMER DRIVE, 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 | DIRECTOR OF HEALTH CARE CONTRACTING
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Name | KIMBERLY CANONIC
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Credential |
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Telephone | 480-277-6348
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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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