# SAM'S CLUB OPTICAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Sam's Club Optical 30-6353
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124123914
- **Authorized official:** KIMBERLY CANONIC (SR. DIRECTOR)
- **Authorized official phone:** (479) 371-1168

## Contact information

- **Practice address:** 1946 10TH AVENUE NORTH, MYRTLE BEACH, SC 29577-5624
- **Practice address phone:** (843) 946-9521
- **Practice address fax:** (843) 916-1481
- **Mailing address:** 1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445

## Taxonomy

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

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 10/14/2025