Active NPI
Sam's West Inc
Doing business as Sam's Vision Center 30-4878
- Eyewear Supplier
- Glen Carbon, IL
National Provider Identifier
1871930289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SAM'S WEST INC
- Doing business as
- Sam's Vision Center 30-4878
- Practice address
- 5 Illini Dr
Glen Carbon, IL 62034-3929 - Phone
- (618) 692-7568
- NPI assigned
- May 24, 2013
- Last updated
- May 24, 2013
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Powers
- Title
- Specialist, Plan Enrollment
- Phone
- (479) 204-0709
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Primary | ||
| Optician | 156FX1800X |
Addresses
Primary practice location
5 Illini Dr
Glen Carbon, IL 62034-3929
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other names 1
- Sam's Vision Center 30-4878
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
- Part of
- Walmart Pharmacy 10-206
Organizations with this tax ID in the same state 15
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
5 Illini Dr
Glen Carbon, IL 62034
Phone (618) 659-7339
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369353600000",
"number": "1871930289",
"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": "727160445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 ILLINI DR",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620343929",
"telephone_number": "618-692-7568"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAM'S WEST INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2013-05-24",
"last_updated": "2013-05-24",
"status": "A",
"authorized_official_last_name": "POWERS",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "SPECIALIST, PLAN ENROLLMENT",
"authorized_official_telephone_number": "479-204-0709"
},
"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 Vision Center 30-4878",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.