Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6535
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J. SIMMONS (NPI ASSOCIATE)
(479) 277-9373
Entity
Organization
Contact information
Practice address
4000 RIB MOUNTAIN DR, WAUSAU, WI 54401-7483
(715) 359-0044
Mailing address
702 SW 8TH STREET, 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
05/31/2007
Last updated
07/17/2008
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