NPIMap

Organization Active NPI

Sam's Club Optical

Doing business as Sam's Club Optical 30-4973

  • Eyewear Supplier
  • Dubuque, IA
National Provider Identifier
1790846830
Registry record updated Sep 11, 2025
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 30-4973
Practice address
4400 Asbury Road
Dubuque, IA 52002
Phone
(563) 587-0591
NPI assigned
Dec 13, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
BJ Rice
Title
Provider Enrollment Specialist
Phone
(479) 277-9835

Specialties & licenses 2

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

Addresses

Primary practice location

4400 Asbury Road
Dubuque, IA 52002

Mailing address

702 SW 8TH St
Bentonville, AR 72716-6209

Other names 1

  • Sam's Club Optical 30-4973 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network283 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1790846830",
    "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": "727166209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 ASBURY ROAD",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "52002",
            "telephone_number": "563-587-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S CLUB OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "BJ",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "479-277-9835"
    },
    "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 30-4973",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dubuque, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.