Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-4972
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J SIMMONS (NPI ASSOCIATE)
(479) 277-9373
Entity
Organization
Contact information
Practice address
1750 SW GATLIN BLVD, PORT ST. LUCIE, FL 34953
(772) 878-1307
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
12/26/2007
Last updated
12/26/2007
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