SAM'S CLUB OPTICAL (NPI# 1114007960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114007960 |
| Entity Type | Organization |
| Organization Name | SAM'S CLUB OPTICAL |
| Other Organization Name | SAM'S CLUB OPTICAL 30-8172 |
| Practice Address |
4831 13th Ave S Fargo ND 58103-7206 |
| Mailing Address |
702 Sw 8th Street Bentonville AR 72716-0235 |
| Practice Telephone | 7012827997 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LINDA M. EPPERSON (NPI COORDINATOR) |
| Authorized Official Telephone | 3167885580 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| X | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Sam's Club Optical 30-8172 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881924413 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 4420 King Avenue East, Billings, MT 59101 | 2010-01-04 |
| 1457589111 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 450 Townsend Road, Cocoa, FL 32926 | 2009-07-01 |
| 1427286251 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 745 W El Camino Alto Drive, Springfield (s), MO 65810 | 2009-07-01 |
| 1093951956 | Sam's Club Optical | Technician/Technologist | 755 N. Hwy 27/441, Lady Lake (the Villages), FL 32159 | 2008-12-24 |
| 1619125903 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 3247 23rd Avenue, Evans, CO 80620 | 2008-08-29 |
| 1720236011 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 2000 Clements Bridge Rd Ste 116, Deptford, NJ 08096-2011 | 2008-08-29 |
| 1184886913 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 11278 South Jordan Gtwy, South Jordan, UT 84095 | 2008-07-02 |
| 1356516116 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 3839 Mundy Mill Road, Oakwood, GA 30566 | 2008-04-23 |
| 1104095801 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 7100 West Arroyo Crossing Pkwy, Las Vegas, NV 89113 | 2008-02-27 |
| 1114101193 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 2650 East Craig Road, North Las Vegas, NV 89030 | 2007-12-26 |
| Street Address |
4831 13TH AVE S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-7206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437296662 | Terry Walsh, PC | Optometrist | 4831 13th Ave S, Fargo, ND 58103-7206 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770833675 | Teresa Lynn Lisburg | Technician/Technologist | 1404 33rd St Sw, Suite 1, Fargo, ND 58103-3482 | 2012-09-18 |
| 1528382900 | Blue Eye Inc | Technician/Technologist | 100 So 4th St, Ste 108, Fargo, ND 58103-1929 | 2010-03-15 |
| 1649343930 | Douglas John Stavenger | Technician/Technologist | 1547 So University Dr, Fargo, ND 58103 | 2006-11-16 |
| 1528175429 | 3-d Optical Inc | Technician/Technologist | 3402 13th Ave S, Suite E, Fargo, ND 58103-6324 | 2006-08-24 |
| 1033606728 | Aspire Optical Co., LLC | Technician/Technologist | 3265 45th St S Ste 104, Fargo, ND 58104-7930 | 2018-04-18 |
| 1699847293 | Midwest Vision Centers Inc | Technician/Technologist | 3051 25th St S, Suite K2, Fargo, ND 58103-6102 | 2006-11-15 |
| 1023198868 | Wal-mart Stores, Inc. | Technician/Technologist | 4731 13th Ave S, Fargo, ND 58103-7205 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104318575 | Kelsie Ann Butts | Technician/Technologist | 1487 E Lasalle Dr, Bismarck, ND 58503-5653 | 2018-06-01 |
| 1508283730 | Wal-mart Stores, Inc. | Technician/Technologist | 1424 Highway 2 E, Devils Lake, ND 58301-4000 | 2014-03-26 |
| 1508291626 | Lighthouse Optical Inc. | Technician/Technologist | 317 Cooper Ave, Grafton, ND 58237 | 2013-09-09 |
| 1235578907 | Wal-mart Stores, Inc | Technician/Technologist | 1000 Old Red Trl Ne, Mandan, ND 58554-1591 | 2013-06-17 |
| 1437451440 | David Pederson | Technician/Technologist | 4551 S Washington St Ste H, Grand Forks, ND 58201-3495 | 2010-11-23 |
| 1619169174 | John Bitz | Technician/Technologist | 210 W Front Ave, Bismarck, ND 58504-5503 | 2007-08-17 |
| 1104906940 | Wal-mart Stores, Inc. | Technician/Technologist | 2003 3rd Ave W, Dickinson, ND 58601-3024 | 2006-10-16 |
| 1316037591 | Sam's Club Optical | Technician/Technologist | 2501 32nd Ave S, Grand Forks, ND 58201-6542 | 2006-10-16 |
| 1922188762 | Wal-mart Stores, Inc. | Technician/Technologist | 2551 32nd Ave S, Grand Forks, ND 58201-6542 | 2006-10-16 |
| 1205916046 | Wal-mart Stores, Inc. | Technician/Technologist | 1901 22nd Ave Sw, Minot, ND 58701-6988 | 2006-10-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.