Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6353
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1946 10TH AVENUE NORTH, MYRTLE BEACH, SC 29577-5624
(843) 946-9521
(843) 916-1481
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/14/2006
Last updated
10/14/2025
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