| NPI | 1760543854 |
|---|---|
| Doing Business As | SAM'S CLUB OPTICAL 30-4906 |
| Entity Type | Organization |
| Authorized Contact | BJ RICE Provider Enrollment Specialist 479-277-9835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |