# SAM'S CLUB OPTICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sam's Club Optical 30-4974
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114101193
- **Authorized official:** DAVID J SIMMONS (NPI ASSOCIATE)
- **Authorized official phone:** (479) 277-9373

## Contact information

- **Practice address:** 2650 EAST CRAIG ROAD, NORTH LAS VEGAS, NV 89030
- **Practice address phone:** (702) 399-3722
- **Mailing address:** 702 SW 8TH ST., BENTONVILLE, AR 72716-0235
- **Mailing address phone:** (479) 277-9373
- **Mailing address fax:** (479) 277-8176

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | — | NULL | Yes |
| 156FX1800X | Optician | — | — | Yes |
| 332H00000X | Eyewear Supplier | — | NULL | — |

## Other

- **Enumeration date:** 12/26/2007
- **Last updated:** 12/26/2007