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General NPI Number Information
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NPI Number | 1770729626
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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 | 12/24/2008
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Last Update Date | 12/24/2008
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Provider Practice Location Address
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Address Line | 1500 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7984
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Country | US
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Telephone | 270-769-1087
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Fax |
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Provider Business Mailing Address
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Address Line | 702 SW 8TH STREET
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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 | OPTICAL INSURANCE PLAN REVIEW
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Name | HOLLY C WILKINSON
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Credential |
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Telephone | 479-204-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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