Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician | |
Eyewear Supplier |
332H00000X | 87 | All Other Suppliers |
| NPI # | 1619038254 |
| LBN Legal business name | SAM'S CLUB OPTICAL |
| Authorized official | MATT MCMULLIN - (DIR, CONTRACTING) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 12/13/2006 |
| Last updated | 07/26/2023 - About 3 years ago |
| Identifiers | n/a |
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