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NPI Code Detail

MEDICARE: SAM'S CLUB OPTICAL

MEDICARE: SAM'S CLUB OPTICAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1053411850
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM'S CLUB OPTICAL
Provider Business Mailing Address
First Line : 702 SW 8TH STREET
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 335 N MILWAUKEE AVE
Second Line :
City : VERNON HILLS
State : IL
Zip : 60061-1561
Country : US
Telephone Number : 847-955-9260
Fax Number :
Authorized Official
Title or Position : NPI COORDINATOR
Name : LINDA M. EPPERSON
Credential :
Telephone Number : 316-788-5580
Provider Enumeration Date : 09/22/2006
Last Update Date : 09/11/2025

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Directions to “SAM'S CLUB OPTICAL ” Practice Location

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