Provider Demographics
NPI:1083957054
Name:SAMS WEST, INC
Entity Type:Organization
Organization Name:SAMS WEST, INC
Other - Org Name:SAMS CLUB VISION CENTER 30-6510
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST PLAN ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-204-8741
Mailing Address - Street 1:702 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:479-204-8741
Mailing Address - Fax:
Practice Address - Street 1:1831 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5449
Practice Address - Country:US
Practice Address - Phone:507-387-8176
Practice Address - Fax:507-387-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty