Sam'S Optical, Penn Square, LLC

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

SAM'S OPTICAL, PENN SQUARE, LLC

Practice address

1900 NW Expressway Ste R1-114
Oklahoma City, OK 73118-1802

Phone

(405) 631-7558

Fax

(405) 631-0615

NPI assigned

Jan 9, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Shelly Bertin

Title

Co-Owner

Phone

(405) 631-7558

Specialties & licenses 1

Addresses

Other names 1

• Sam's Optical Other name

Locations

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231459200000",
    "number": "1861639080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 NW EXPRESSWAY STE R1-114",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731181802",
            "telephone_number": "405-631-7558",
            "fax_number": "405-631-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 NW EXPRESSWAY STE R1-114",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731181802",
            "telephone_number": "405-631-7558",
            "fax_number": "405-631-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S OPTICAL, PENN SQUARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-09",
        "last_updated": "2009-01-09",
        "status": "A",
        "authorized_official_last_name": "BERTIN",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "405-631-7558",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Optical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sam'S East, Inc.
• Sam'S East, Inc.
• Sam'S East, Inc.
• Sam'S Optical, Oklahoma City LLC
• Sam'S Optical, Oklahoma City, LLC
• Sophia Samadian, M. ED
• Rajesh Samannan, M.D.,
• Priya Samant, M.D.
• Himanshu S Samantaray, OTR/L, CHT
• Elizabeth Dee Samara, M.A.

• Optician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Optician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; 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.