Organization
SAM'S CLUB OPTICAL
Active
Other names
Sam's Club Optical 30-6331
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY C WILKINSON (CARRIER SPECIALIST)
(479) 204-8320
Entity
Organization
Contact information
Practice address
3300 BRUMBACK BLVD, SOMERS, WI 53140
(262) 554-2052
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
07/01/2009
Last updated
07/01/2009
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