SAM'S WEST, INC (NPI# 1275945255) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275945255 |
| Entity Type | Organization |
| Organization Name | SAM'S WEST, INC |
| Other Organization Name | SAM'S CLUB VISION CENTER 30-6388 |
| Practice Address |
1050 Ogden Ave Montgomery IL 60538-5404 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 6304491953 |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |
| Authorized Official Name | LAURA LEVINE (DIR HEALTHCARE CONTRACTING & ENROLL) |
| Authorized Official Telephone | 4792048550 |
| Is Organization Subpart | Y |
| Parent Organization Name | WAL-MART STORES, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| SAM'S CLUB VISION CENTER 30-6388 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407251630 | Sam's West, Inc | Technician/Technologist | 601 S Placentia Ave, Fullerton, CA 92831 | 2014-10-30 |
| 1366835514 | Sam's West, Inc | Technician/Technologist | 4625 Se Delaware Ave, Ankeny, IA 50021-9351 | 2015-03-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SAM'S WEST, INC. | 702 Sw 8th St, Bentonville, AR 72716 |
| Colorado Business Entities | SAM'S WEST, INC. | 708 Sw 8th Street, Bentonville, AR 72716 |
| Iowa Business Entities | SAM'S WEST, INC. | 708 Sw 8th Street, Bentonville, AR 72716 |
| Massachusetts Corporations | SAM'S WEST, INC. | 702 Sw 8th Street, Bentonville, AR 72716 |
| Washington State Corporations | SAM'S WEST, INC. | 708 Sw 8th Street, Bentonville, AR 72716 |
| Vermont Business Registrations | SAM'S WEST, INC. | 702 Sw 8th Street, Bentonville, AR 72716 |
| Street Address |
1050 OGDEN AVE |
| City | MONTGOMERY |
| State | IL |
| Zip Code | 60538-5404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295152635 | Sams West Inc | Durable Medical Equipment & Medical Supplies | 1050 Ogden Ave, Montgomery, IL 60538-5404 | 2014-03-24 |
| 1720688856 | Donna Slas | Pharmacist | 1050 Ogden Ave, Montgomery, IL 60538-5404 | 2020-10-28 |
| 1740697408 | Kevin Goodwin | Optometrist | 1050 Ogden Ave, Montgomery, IL 60538-5404 | 2014-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447594296 | Kristina Nancy Hajek | Physician Assistant | 1851 Douglas Road, Montgomery, IL 60538 | 2012-11-17 |
| 1003025248 | Matthew Thomas Neu | Preventive Medicine | 325 Route 31, Caterpillar Inc, Medical Division, Montgomery, IL 60538 | 2007-05-22 |
| 1477761567 | West Suburban Dental Care, Ltd. | Dentist | 1901 Douglas Rd, Montgomery, IL 60538 | 2007-05-20 |
| 1093834079 | David D Leger | Chiropractor | 2100 Baseline Rd, Montgomery, IL 60538 | 2007-03-28 |
| 1790816650 | Tina Elizabeth Sunderland | Specialist/Technologist | 22 Ashlawn Ave, Montgomery, IL 60538 | 2007-03-09 |
| 1720126535 | Nicholas George Tzanetakos | Family Medicine | 99 Boulder Hill Pass, Montgomery, IL 60538 | 2007-02-02 |
| 1184638603 | Neil Stewart Schlupp | Chiropractor | 212 Webster Street, Montgomery, IL 60538 | 2006-07-28 |
| 1275570061 | Ridge Ambulance Service Inc | Ambulance | 1851 Aucutt Rd, Montgomery, IL 60538 | 2006-06-01 |
| 1487855839 | Linda Gioia Arrich | Dentist | 1901 Douglas Rd, Montgomery, IL 60538 | 2007-05-31 |
| 1750508339 | Michael Harry Kontos | Dentist | 20 Boulder Hill Pass, Montgomery, IL 60538 | 2007-04-18 |
| Find all providers in zip 60538 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144844291 | Eyestyle of America Ltd | Eyewear Supplier (Equipment, not the service) | 10700 Montgomery Rd Ste 221, Montgomery, OH 45242-3296 | 2020-06-04 |
| 1467710673 | Us Vision Optical Inc. | Eyewear Supplier (Equipment, not the service) | 1236 Eastdale Mall, Montgomery, AL 36117-2154 | 2012-04-25 |
| 1801960232 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1500 Edale Mall, Eastdale Mall, Montgomery, AL 36117-2120 | 2006-11-18 |
| 1174531750 | Carmichael Optical Shoppe, Inc | Eyewear Supplier (Equipment, not the service) | 4255 Carmichael Court N, Montgomery, AL 36106 | 2006-08-03 |
| 1831155332 | Prescription Eyewear, Inc. | Eyewear Supplier (Equipment, not the service) | 8131 Seaton Pl, Montgomery, AL 36116-7205 | 2006-04-24 |
| 1376522185 | Bfc Affordable, Inc. | Eyewear Supplier (Equipment, not the service) | 324 Madison Ave, Montgomery, AL 36104-3628 | 2006-01-10 |
| 1508868399 | Prescription Eyewear Inc. | Eyewear Supplier (Equipment, not the service) | 2752 Zelda Rd, Montgomery, AL 36106-2694 | 2005-08-11 |
| 1629462767 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 8251 Eastchase Pkwy, Montgomery, AL 36117-7033 | 2015-03-26 |
| 1316345366 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 6520 Atlanta Hwy, Montgomery, AL 36117-4245 | 2014-12-08 |
| 1619155736 | East Montgomery Optical Shoppe | Eyewear Supplier (Equipment, not the service) | 262 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2008-01-31 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 60538 |
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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.