Provider Demographics
NPI:1407492465
Name:SAM'S EAST, INC.
Entity Type:Organization
Organization Name:SAM'S EAST, INC.
Other - Org Name:SAM'S OPTICAL CENTER 30-7189
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-277-2500
Mailing Address - Street 1:4101 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6239
Mailing Address - Country:US
Mailing Address - Phone:479-204-1258
Mailing Address - Fax:479-277-4331
Practice Address - Street 1:4101 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6239
Practice Address - Country:US
Practice Address - Phone:479-204-1258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty