Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30 4718
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J SIMMONS (NPI ASSOCIATE)
(479) 277-9373
Entity
Organization
Contact information
Practice address
11278 SOUTH JORDAN GTWY, SOUTH JORDAN, UT 84095
(801) 545-9801
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
(479) 277-9373
(479) 277-8176
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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