Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6472
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BOYD (CONTRACT COORDINATOR)
(479) 277-1359
Entity
Organization
Contact information
Practice address
3221 MANAWA CENTRE DR, COUNCIL BLUFFS, IA 51501-7672
(712) 366-0130
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/11/2006
Last updated
09/11/2025
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