# SAM'S CLUB OPTICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sam's Club Optical 30-4992
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770729626
- **Authorized official:** HOLLY C WILKINSON (OPTICAL INSURANCE PLAN REVIEW)
- **Authorized official phone:** (479) 204-8320

## Contact information

- **Practice address:** 1500 RING RD, ELIZABETHTOWN, KY 42701-7984
- **Practice address phone:** (270) 769-1087
- **Mailing address:** 702 SW 8TH STREET, BENTONVILLE, AR 72716-0235

## Taxonomy

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

## Other

- **Enumeration date:** 12/24/2008
- **Last updated:** 12/24/2008