Organization
SAM'S CLUB OPTICAL
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Club Optical 30-4728
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
DIANNA PAINTER (ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
140 KOHLS DR, NICHOLASVILLE, KY 40356
(859) 881-0431
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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