Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-8138
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA M. EPPERSON (NPI COORDINATOR)
(316) 788-5580
Entity
Organization
Contact information
Practice address
1460 CORNERSTONE DR, DAYTONA BEACH, FL 32117
(386) 760-2303
(386) 760-0952
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/28/2006
Last updated
07/25/2019
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