Organization · NPI-2

Sam'S Club Optical

Eyewear Supplier (Equipment, not the service) · Gaithersburg, MD

NPI number1649379173
StatusActive
Last updated in NPPESSep 29, 2025

Details

NPI
1649379173
Entity type
Organization (NPI-2)
Legal business name
Sam'S Club Optical
Organization subpart
No
Enumeration date
Sep 21, 2006
Certification date
Sep 29, 2025
Last updated
Sep 29, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332H00000X Eyewear Supplier (Equipment, not the service)––Yes
156FX1800X Technician/Technologist, Optician––

Other names

  • Sam'S Club Optical 30-6653 (Doing Business As)

Practice location

610 N Frederick Ave
Gaithersburg, MD 20877-2527

Phone 240-631-7716 · Fax 240-631-7819

Mailing address

1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445

Authorized official

Kimberly Canonic
Sr. Director
4793711168

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