SAM'S CLUB OPTICAL (NPI# 1568562619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568562619 |
| Entity Type | Organization |
| Organization Name | SAM'S CLUB OPTICAL |
| Other Organization Name | SAM'S CLUB OPTICAL 30-6349 |
| Practice Address |
9400 S Western Ave Evergreen Park IL 60805-2509 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-6209 |
| Practice Telephone | 7084227417 |
| Enumeration Date | 2006-09-25 |
| 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 30-6349 | 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 |
9400 S WESTERN AVE |
| City | EVERGREEN PARK |
| State | IL |
| Zip Code | 60805-2509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912965823 | Mark Douglas Wilmoth | Optometrist | 9400 S Western Ave, Evergreen Park, IL 60805-2509 | 2006-05-02 |
| 1134729122 | Kimberly Denise Holmes | Pharmacist | 9400 S Western Ave, Evergreen Park, IL 60805-2509 | 2020-10-28 |
| 1326661356 | Sarah Orsi | Hearing Instrument Specialist | 9400 S Western Ave, Evergreen Park, IL 60805-2509 | 2020-05-26 |
| 1831415702 | Micaela Toledo | Optometrist | 9400 S Western Ave, Evergreen Park, IL 60805-2509 | 2010-04-15 |
| 1205853595 | Sams West Inc | Durable Medical Equipment & Medical Supplies | 9400 S Western Ave, Evergreen Park, IL 60805-2509 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254603 | Cynthia Nicole Bucio | Pharmacist | 9400 S. Western, Evergreen Park, N/A 60805 | 2020-10-27 |
| 1124530456 | Foundations Counseling, LLC | Social Worker | 9730 S Western Ave Ste 215, Evergreen Park, IL 60805 | 2017-10-26 |
| 1184147886 | Luke Blaeser | Specialist/Technologist | 2856 W. 97th Pl., Evergreen Park, IL 60805 | 2017-07-25 |
| 1396193322 | Daniel Joseph Bierbaum Howard | Emergency Medicine | 2800 95th St, Emergency Department, Evergreen Park, IL 60805 | 2016-05-31 |
| 1588037873 | Lcr Primary Care LLC | Exclusive Provider Organization | 9237 S.pulaski, Ste. 2s, Evergreen Park, IL 60805 | 2015-11-09 |
| 1447639091 | Nancy Sanchez | Social Worker | 9832 S Utica Ave, Evergreen Park, IL 60805 | 2015-05-28 |
| 1629334743 | Harshad M. Mehta Md Sc | Psychiatry & Neurology | 2850 W. 95th Street, Suite 206, Evergreen Park, IL 60805 | 2012-04-03 |
| 1235407305 | Victoria T Adesina | Pharmacist | 8700 South Kedzie Ave, Evergreen Park, IL 60805 | 2011-12-05 |
| 1891072922 | Zahia-lena Refat Hussien | Pharmacist | 8700 S. Kedzie Ave, Evergreen Park, IL 60805 | 2011-11-03 |
| 1891079091 | Denise Adams | Occupational Therapy Assistant | 9217 S. Kedzie, Evergreen Park, IL 60805 | 2011-10-06 |
| Find all providers in zip 60805 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821132515 | Angelita M Gowin | Technician/Technologist | 3541 W 95th St, Evergreen Park, IL 60805-2135 | 2007-02-16 |
| 1841375151 | Wal-mart Stores, Inc | Technician/Technologist | 2500 W 95th St, Evergreen Park, IL 60805-2807 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902445570 | Kami Optical Corp | Technician/Technologist | 1163 E Ogden Ave Ste 701, Naperville, IL 60563-8535 | 2019-12-31 |
| 1750847281 | National Vision Inc | Technician/Technologist | 750 S Rand Rd, Lake Zurich, IL 60047-2467 | 2019-02-20 |
| 1700364171 | National Vision Inc | Technician/Technologist | 4068 North Milwaukee Avenue, Chicago, IL 60641 | 2018-07-30 |
| 1720571615 | National Vision, Inc. | Technician/Technologist | 6931 Grand Ave Ste E2, Gurnee, IL 60031-1610 | 2018-06-14 |
| 1023528619 | Direct Healthcare Solutions LLC | Technician/Technologist | 1520 Fringetree Ln, Woodridge, IL 60517-4653 | 2017-10-09 |
| 1184140014 | Efp Opticians On Dearborn, LLC | Technician/Technologist | 1205 N Dearborn St, Chicago, IL 60610-2213 | 2017-08-22 |
| 1235668245 | Vision Man | Technician/Technologist | 8335 Grand Ave, River Grove, IL 60171-1434 | 2017-06-05 |
| 1033662200 | National Vision, Inc. | Technician/Technologist | 348 W Army Trail Rd, Suite 130, Bloomingdale, IL 60108-5608 | 2016-07-25 |
| 1780039115 | Wal-mart Stores, Inc. | Technician/Technologist | 365 Lake Marian Road, Carpentersville, IL 60110 | 2016-05-04 |
| 1346695392 | National Vision, Inc. | Technician/Technologist | 714 S Randall Rd, Algonquin, IL 60102-5915 | 2016-04-27 |
| Find all providers with the same taxonomy | ||||
| City | EVERGREEN PARK |
| Zip Code | 60805 |
Please comment or provide details below to improve the information on SAM'S CLUB OPTICAL.
| 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.