Active NPI
Sam's East Inc
Doing business as Sam's Club Optical 30-8194
- Eyewear Supplier
- Athens, GA
National Provider Identifier
1578652194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SAM'S EAST INC
- Doing business as
- Sam's Club Optical 30-8194
Sam's Optical Center 30-8194 - Practice address
- 4365 Atlanta Hwy
Athens, GA 30606-0808 - Phone
- (706) 548-2824
- Fax
- (706) 548-9676
- NPI assigned
- Oct 12, 2006
- Last updated
- Jun 15, 2026
- 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
- Kimberly Canonic
- Title
- Sr Director
- Phone
- (480) 853-0515
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Primary | ||
| Optician | 156FX1800X |
Addresses
Primary practice location
4365 Atlanta Hwy
Athens, GA 30606-0808
Mailing address
1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445
Other names 2
- Sam's Club Optical 30-8194
- Sam's Optical Center 30-8194
National Provider Directory
National Provider Directory- Tax ID family
- Sams Club Optical
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.
Locations
4365 Atlanta Hwy
Athens, GA 30606
Phone (706) 548-1913
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Optician
- Athens, GA
- NPI 1457180044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1781481600000",
"number": "1578652194",
"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": "4365 ATLANTA HWY",
"city": "ATHENS",
"state": "GA",
"postal_code": "306060808",
"telephone_number": "706-548-2824",
"fax_number": "706-548-9676"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAM'S EAST INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-12",
"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": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Sam's Club Optical 30-8194",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sam's Optical Center 30-8194",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Athens, GA
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.