Organization
SAM'S WEST, INC.
Active
Organization
SAM'S WEST, INC.
Active
Parent organization
WAL-MART STORES, INC.
Other names
Sam's Optical Center 30-4853
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES, INC.
Authorized official
KELSEY GENEVICH (MANAGER, CONTRACTING AND ENROLLMENT)
(479) 258-6724
Entity
Organization
Contact information
Practice address
5940 PROMENADE PKWY, CASTLE ROCK, CO 80108
(303) 379-8039
(303) 379-8038
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6724
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
12/12/2016
Last updated
12/23/2016
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