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Organization Active NPI

Sam's Club Optical

Doing business as Sam's Club Optical 30-4972

  • Optician
  • Port St Lucie, FL
National Provider Identifier
1467636449
Registry record updated Dec 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
SAM'S CLUB OPTICAL
Doing business as
Sam's Club Optical 30-4972
Practice address
1750 SW Gatlin Blvd
Port St. Lucie, FL 34953
Phone
(772) 878-1307
NPI assigned
Dec 26, 2007
Last updated
Dec 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2007

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

Authorized official

Name
David J Simmons
Title
Npi Associate
Phone
(479) 277-9373

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU
Optician 156FX1800X NU Primary

Addresses

Primary practice location

1750 SW Gatlin Blvd
Port St. Lucie, FL 34953

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0235
Phone (479) 277-9373

Other names 1

  • Sam's Club Optical 30-4972 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sams Club Optical821 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

1750 SW Gatlin Blvd
Port St Lucie, FL 34953
Phone (772) 878-1307

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1467636449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160235",
            "telephone_number": "479-277-9373",
            "fax_number": "479-277-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 SW GATLIN BLVD",
            "city": "PORT ST. LUCIE",
            "state": "FL",
            "postal_code": "34953",
            "telephone_number": "772-878-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S CLUB OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NPI ASSOCIATE",
        "authorized_official_telephone_number": "479-277-9373"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Club Optical 30-4972",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.