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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
1332H00000XEyewear Supplier
2156FX1800XOptician

General Provider Information

NPI Number : 1104095801
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM'S CLUB OPTICAL
Provider Business Mailing Address
First Line : 702 SW 8TH ST.
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716
Country : US
Telephone Number : 479-277-9373
Fax Number : 479-277-8176
Provider Business Practice Location Address
First Line : 7100 WEST ARROYO CROSSING PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113
Country : US
Telephone Number : 702-260-7303
Fax Number :
Authorized Official
Title or Position : NPI ASSOCIATE
Name : DAVID J SIMMONS
Credential :
Telephone Number : 479-277-9373
Provider Enumeration Date : 02/27/2008
Last Update Date : 02/27/2008

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Directions to “SAM'S CLUB OPTICAL ” Practice Location

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