NPIMap

Organization Active NPI

Sam's East, Inc.

Doing business as Sam's Optical Center 30-7673

  • Eyewear Supplier
  • Lebanon, TN
National Provider Identifier
1669350781
Registry record updated May 19, 2026
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 Optical Center 30-7673
Practice address
600 Willard Hagan Dr
Lebanon, TN 37090
Phone
(615) 994-4119
NPI assigned
Aug 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Kimberly Canonic
Title
Director of Health Care Contracting
Phone
(480) 277-6348

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

600 Willard Hagan Dr
Lebanon, TN 37090

Mailing address

1 Customer Dr # Ms 0445
Bentonville, AR 72716-0445

Other names 1

  • Sam's Optical Center 30-7673 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sam's Hearing Aid Center 6332819 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1756166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1669350781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR # MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WILLARD HAGAN DR",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "37090",
            "telephone_number": "615-994-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S EAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-26",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH CARE CONTRACTING",
        "authorized_official_telephone_number": "480-277-6348"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-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 Optical Center 30-7673",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.