Active NPI
Sam's Club Optical
Doing business as Sam's Club Optical 30-6661
- Eyewear Supplier
- Portage, MI
National Provider Identifier
1932200896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SAM'S CLUB OPTICAL
- Doing business as
- Sam's Club Optical 30-6661
- Practice address
- 665 Mall Dr
Portage, MI 49024-2879 - Phone
- (269) 323-2700
- NPI assigned
- Sep 25, 2006
- Last updated
- Sep 11, 2025
- 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
- Linda M. Epperson
- Title
- Npi Coordinator
- Phone
- (316) 788-5580
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | |||
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
665 Mall Dr
Portage, MI 49024-2879
Mailing address
702 SW 8TH Street
Bentonville, AR 72716-0235
Other names 1
- Sam's Club Optical 30-6661
National Provider Directory
National Provider Directory- Tax ID family
- Sams East
Organizations with this tax ID in the same state 14
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
665 Mall Dr
Portage, MI 49024
Phone (269) 323-2700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1932200896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH STREET",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 MALL DR",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490242879",
"telephone_number": "269-323-2700"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAM'S CLUB OPTICAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "EPPERSON",
"authorized_official_first_name": "LINDA",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "NPI COORDINATOR",
"authorized_official_telephone_number": "316-788-5580"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "193400000X MULTIPLE SINGLE 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 Club Optical 30-6661",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Portage, MI
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.