Provider Demographics
NPI:1760713804
Name:SAMS CLUB #6515
Entity Type:Organization
Organization Name:SAMS CLUB #6515
Other - Org Name:SAMS CLUB OPTICA #6515
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RETAIL ESTRATEGIC 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:PLAZA HUMACAO
Mailing Address - Street 2:CARR #3 KM 82.0
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741
Mailing Address - Country:US
Mailing Address - Phone:787-285-8815
Mailing Address - Fax:
Practice Address - Street 1:PLAZA HUMACAO
Practice Address - Street 2:CARR #3 KM 82.0
Practice Address - City:PUNTA SANTIAGO
Practice Address - State:PR
Practice Address - Zip Code:00741
Practice Address - Country:US
Practice Address - Phone:787-285-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier