Provider Demographics
NPI:1245562081
Name:SAMS CLUB #6543
Entity Type:Organization
Organization Name:SAMS CLUB #6543
Other - Org Name:SAMS CLUB OPTICAL #6543
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RETAIL STRATEGIC BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-8094
Mailing Address - Street 1:P.O. BOX 6010
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-257-5230
Mailing Address - Fax:787-257-1934
Practice Address - Street 1:PARQUE ESCORIAL
Practice Address - Street 2:BO. SAN ANTON CARR. #3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-257-5230
Practice Address - Fax:787-257-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier