NPIMap

Organization Active NPI

Sam's East, Inc.

Doing business as Sam's Club Optical 30-4828

  • Eyewear Supplier
  • Orlando, FL
National Provider Identifier
1104374420
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SAM'S EAST, INC.
Doing business as
Sam's Club Optical 30-4828
Practice address
11920 Narcoossee Rd
Orlando, FL 32832-0000
Phone
(407) 204-8622
Fax
(407) 816-8164
NPI assigned
Sep 15, 2016
Last updated
Jan 4, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Levine
Title
Dir Healthcare Contract & Enroll
Phone
(479) 204-8550

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 156FX1800X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

11920 Narcoossee Rd
Orlando, FL 32832-0000

Mailing address

702 SW 8TH St
Ms 0445
Bentonville, AR 72716-0445
Phone (479) 204-8550

Other names 1

  • Sam's Club Optical 30-4828 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sams East824 organizations share this tax ID, including this one
Part of
Wal Mart Pharmacy 10 2039

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

11920 Narcoossee Rd
Orlando, FL 32832
Phone (407) 204-8614

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1104374420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "address_2": "MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-8550",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11920 NARCOOSSEE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328320000",
            "telephone_number": "407-204-8622",
            "fax_number": "407-816-8164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S EAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES, INC.",
        "enumeration_date": "2016-09-15",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIR HEALTHCARE CONTRACT & ENROLL",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Club Optical 30-4828",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.