Provider Demographics
NPI:1851597645
Name:SAM'S CLUB OPTICAL
Entity Type:Organization
Organization Name:SAM'S CLUB OPTICAL
Other - Org Name:SAM'S CLUB OPTICAL 30-8298
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NPI ASSOCIATE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-277-1175
Mailing Address - Street 1:702 SW 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0235
Mailing Address - Country:US
Mailing Address - Phone:479-277-1175
Mailing Address - Fax:479-277-8174
Practice Address - Street 1:321 S LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-1249
Practice Address - Country:US
Practice Address - Phone:815-744-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear Supplier