SAM'S CLUB OPTICAL (NPI# 1609962943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609962943 |
| Entity Type | Organization |
| Organization Name | SAM'S CLUB OPTICAL |
| Other Organization Name | SAM'S CLUB OPTICAL 30-4740 |
| Practice Address |
465 Goodman Rd E Southaven MS 38671-9525 |
| Mailing Address |
702 Sw 8th Street Bentonville AR 72716 |
| Practice Telephone | 6623490723 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LINDA M. EPPERSON (NPI COORDINATOR) |
| Authorized Official Telephone | 3167885580 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| X | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Sam's Club Optical 30-4740 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881924413 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 4420 King Avenue East, Billings, MT 59101 | 2010-01-04 |
| 1457589111 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 450 Townsend Road, Cocoa, FL 32926 | 2009-07-01 |
| 1427286251 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 745 W El Camino Alto Drive, Springfield (s), MO 65810 | 2009-07-01 |
| 1093951956 | Sam's Club Optical | Technician/Technologist | 755 N. Hwy 27/441, Lady Lake (the Villages), FL 32159 | 2008-12-24 |
| 1619125903 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 3247 23rd Avenue, Evans, CO 80620 | 2008-08-29 |
| 1720236011 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 2000 Clements Bridge Rd Ste 116, Deptford, NJ 08096-2011 | 2008-08-29 |
| 1184886913 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 11278 South Jordan Gtwy, South Jordan, UT 84095 | 2008-07-02 |
| 1356516116 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 3839 Mundy Mill Road, Oakwood, GA 30566 | 2008-04-23 |
| 1104095801 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 7100 West Arroyo Crossing Pkwy, Las Vegas, NV 89113 | 2008-02-27 |
| 1114101193 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 2650 East Craig Road, North Las Vegas, NV 89030 | 2007-12-26 |
| Street Address |
465 GOODMAN RD E |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-9525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528085941 | Sams East Inc | Durable Medical Equipment & Medical Supplies | 465 Goodman Rd E, Southaven, MS 38671-9525 | 2006-07-16 |
| 1326649849 | Nathan Rucker | Pharmacist | 465 Goodman Rd E, Southaven, MS 38671-9525 | 2020-11-02 |
| 1104427640 | Anish K Patel | Pharmacist | 465 Goodman Rd E, Southaven, MS 38671-9525 | 2020-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770822454 | Gemetric Tammorius Thomas | Technician/Technologist | 9125 Millbranch, Southaven, MS 38671-1421 | 2013-01-31 |
| 1326126566 | Wal-mart Stores East, Lp | Technician/Technologist | 6811 Southcrest Pkwy, Southaven, MS 38671-9538 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790289510 | Shana Thedford | Technician/Technologist | 3220 Lauderdale Rd, Lauderdale, MS 39335-9639 | 2018-03-19 |
| 1003354580 | Wal-mart Stores East, Lp | Technician/Technologist | 2129 Grand Ave, Yazoo City, MS 39194 | 2017-02-06 |
| 1427505742 | National Vision, Inc. | Technician/Technologist | Bldg 160 Simler Blvd, Columbus, MS 39705 | 2016-09-02 |
| 1184098733 | Wal-mart Stores East, Lp | Technician/Technologist | 4150 Goodman Road West, Horn Lake, MS 38637 | 2015-11-19 |
| 1659612836 | Harold Bernard Brewer Jr. | Technician/Technologist | 1171 Johns Mayton Rd, Brandon, MS 39042-8364 | 2013-03-12 |
| 1427337492 | Clear View Vision Care | Technician/Technologist | 4612 Medgar Evers Blvd ., Suite 9, Jackson, MS 39213 | 2011-08-09 |
| 1548585763 | Optical Center | Technician/Technologist | 506 Larcher Blvd Bldg 2306, Keesler Afb, MS 39534-2342 | 2010-03-30 |
| 1841513348 | Marc Mclendon | Technician/Technologist | 75 Kirk Ave, Grenada, MS 38901-2839 | 2010-03-11 |
| 1528236973 | Patricia Hammons | Technician/Technologist | 661 Duling Ave, Jackson, MS 39216-4008 | 2008-02-19 |
| 1689852519 | Cleveland Optical Inc | Technician/Technologist | 802 1st St, Cleveland, MS 38732-2310 | 2008-02-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.