Provider Demographics
NPI:1508200379
Name:SAMS WEST, INC.
Entity Type:Organization
Organization Name:SAMS WEST, INC.
Other - Org Name:SAMS CLUB VISION CENTER 30-6425
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 1:4600 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4224
Practice Address - Country:US
Practice Address - Phone:307-237-3362
Practice Address - Fax:307-237-3475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAL-MART STORES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty