Organization
SAM'S WEST, INC
Active
Parent organization
WAL-MART STORES, INC
Other names
SAM'S CLUB VISION CENTER 30-6388
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES, INC
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1050 OGDEN AVE, MONTGOMERY, IL 60538-5404
(630) 449-1953
(630) 449-1954
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
05/27/2014
Last updated
09/29/2025
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