Active NPI
Sam's Club Optical
Doing business as Sam's Club Optical 30-6412
- Eyewear Supplier
- Southgate, MI
National Provider Identifier
1013009208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SAM'S CLUB OPTICAL
- Doing business as
- Sam's Club Optical 30-6412
- Practice address
- 15700 Northline Rd
Southgate, MI 48195-2378 - Phone
- (734) 285-0030
- NPI assigned
- Sep 28, 2006
- Last updated
- Sep 11, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Linda M. Epperson
- Title
- Npi Coordinator
- Phone
- (316) 788-5580
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | NU | Primary | |
| Optician | 156FX1800X | NU |
Addresses
Primary practice location
15700 Northline Rd
Southgate, MI 48195-2378
Mailing address
702 SW 8TH Street
Bentonville, AR 72716-0235
Other names 1
- Sam's Club Optical 30-6412
National Provider Directory
National Provider Directory- Tax ID family
- Sams Club Optical
Organizations with this tax ID in the same state 14
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Eyewear Supplier
- Roseville, MI
- NPI 1295827764
-
dba Sams Pharmacy 10-6659
- Community/Retail Pharmacy
- Madison Heights, MI
- NPI 1275550642
Locations
15700 Northline Rd
Southgate, MI 48195
Phone (734) 281-4863
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1013009208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH STREET",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15700 NORTHLINE RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952378",
"telephone_number": "734-285-0030"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAM'S CLUB OPTICAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-28",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "EPPERSON",
"authorized_official_first_name": "LINDA",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "NPI COORDINATOR",
"authorized_official_telephone_number": "316-788-5580"
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Sam's Club Optical 30-6412",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.