NPIMap

Organization Active NPI

Sam's Club Optical

Doing business as Sam's Club Optical 30-4728

  • Eyewear Supplier
  • Nicholasville, KY
National Provider Identifier
1295040665
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SAM'S CLUB OPTICAL
Doing business as
Sam's Club Optical 30-4728
Sam's Optical Center 30-4728
Practice address
103 Bryant Drive
Nicholasville, KY 40356-9225
Phone
(859) 881-0695
Fax
(859) 881-0698
NPI assigned
Aug 10, 2010
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Authorized official

Name
Kimberly Canonic
Title
Sr Director
Phone
(480) 853-0515

Specialties & licenses 2

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

Addresses

Primary practice location

103 Bryant Drive
Nicholasville, KY 40356-9225

Mailing address

1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445

Other names 2

  • Sam's Club Optical 30-4728 Doing business as
  • Sam's Optical Center 30-4728 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

140 Kohls Dr
Nicholasville, KY 40356
Phone (859) 881-1647

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1295040665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "address_2": "MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 BRYANT DRIVE",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403569225",
            "telephone_number": "859-881-0695",
            "fax_number": "859-881-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S CLUB OPTICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2010-08-10",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "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 30-4728",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Optical Center 30-4728",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nicholasville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.