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NPI Code Detail

MEDICARE: SAM'S EAST, INC.

MEDICARE: SAM'S EAST, 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
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1902299746
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM'S EAST, INC.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line : MS 0445
City : BENTONVILLE
State : AR
Zip : 72716-6209
Country : US
Telephone Number : 479-277-2500
Fax Number :
Provider Business Practice Location Address
First Line : 200 EMILY DR
Second Line :
City : CLARKSBURG
State : WV
Zip : 26301-5500
Country : US
Telephone Number : 479-277-2500
Fax Number :
Authorized Official
Title or Position : DIR HEALTHCARE CONTRACT & ENROLL
Name : LAURA LEVINE
Credential :
Telephone Number : 479-204-8550
Provider Enumeration Date : 03/17/2015
Last Update Date : 03/17/2015

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