Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6653
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
610 N FREDERICK AVE, GAITHERSBURG, MD 20877-2527
(240) 631-7716
(240) 631-7819
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
09/21/2006
Last updated
09/29/2025
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