Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6644
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J SIMMONS (NPI ASSOCIATE)
(479) 277-9373
Entity
Organization
Contact information
Practice address
3839 MUNDY MILL ROAD, OAKWOOD, GA 30566
(770) 287-7716
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
04/23/2008
Last updated
04/23/2008
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