MEDICARE: SAMS WEST, INC.

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
1	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1508200379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS WEST, INC.

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-204-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 E 2ND ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4224
Country	:	US
Telephone Number	:	307-237-3362
Fax Number	:	307-237-3475

Authorized Official
Title or Position	:	SPECIALIST PLAN ENROLLMENT
Name	:	DEB LAUVER
Credential	:
Telephone Number	:	479-204-8741

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/03/2014

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Directions to “SAMS WEST, INC. ” Practice Location

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