SAM'S OPTICAL, PENN SQUARE, LLC (NPI# 1861639080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861639080 |
| Entity Type | Organization |
| Organization Name | SAM'S OPTICAL, PENN SQUARE, LLC |
| Other Organization Name | SAM'S OPTICAL |
| Practice Address |
1900 Nw Expressway Ste R1-114 Oklahoma City OK 73118-1802 |
| Practice Telephone | 4056317558 |
| Practice Fax Number | 4056310615 |
| Mailing Telephone | 4056317558 |
| Mailing Fax Number | 4056310615 |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-01-09 |
| Authorized Official Name | MS. SHELLY BERTIN (CO-OWNER) |
| Authorized Official Telephone | 4056317558 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Sam's Optical | Other Name - Individual/Organization |
| Street Address |
1900 NW EXPRESSWAY STE R1-114 |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73118-1802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255812772 | Karrie Danea Moreno | Behavior Technician | 1507 Ne 31st, Oklahoma, OK 73118 | 2018-08-23 |
| 1528578499 | Revive Medical LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118 | 2017-10-05 |
| 1225556228 | Anika Carr | Case Manager/Care Coordinator | 1212 Nw 32nd Street, Oklahoma City, OK 73118 | 2017-08-30 |
| 1740635168 | Nikhil Malhotra | Internal Medicine | 3635 Vista Avenue At Grand Boulevard, 14th Floor, Desloge Towers, St. Louis, MO 73118 | 2016-05-04 |
| 1144694183 | Christopher Woon | Counselor | 4001 N Classen, Suite 105, Oklahoma City, OK 73118 | 2015-11-13 |
| 1699181925 | Stac Embry | Counselor | 3321 N. Mckinley Ave, Oklahoma City, OK 73118 | 2014-07-08 |
| 1194161216 | Jennifer Kaye Powers | Counselor | 3124 N. Classen Blvd., Ste. A, Oklahoma City, OK 73118 | 2013-05-15 |
| 1932445491 | Jessica Camp | Behavioral Analyst | 3220 N Harvey Pkwy, Oklahoma City, OK 73118 | 2013-01-02 |
| 1942578661 | Michael D Danielson | Behavioral Analyst | 4232 N Sante Fe Ave, Oklahoma City, OK 73118 | 2011-12-08 |
| 1912280587 | Tara Roberts | Counselor | 1743 Nw 37th, Oklahoma City, OK 73118 | 2011-09-21 |
| Find all providers in zip 73118 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376064592 | Focus Optical Inc. | Technician/Technologist | 12444 Nw 10th St, Bldg H Ste 101, Oklahoma City, OK 73119 | 2017-06-28 |
| 1386814432 | Sam's Crossroads Optical | Technician/Technologist | 1078 Crossroads Mall, Ste D, Oklahoma City, OK 73149-4202 | 2008-03-05 |
| 1255530754 | Sam J Edwards Jr. | Technician/Technologist | 1078 Crossroads Mall Ste D, Oklahoma City, OK 73149-4202 | 2007-07-13 |
| 1396941712 | Ronald Lee Brazell | Technician/Technologist | 1900 Nw 39th St, Oklahoma City, OK 73118 | 2007-06-22 |
| 1861696379 | David Allen Trent | Technician/Technologist | 5631 N Pennsylvania Ave, Oklahoma City, OK 73112-7769 | 2007-06-11 |
| 1225135320 | Tom W. Wilkinson | Technician/Technologist | 1010 N Pennsylvania Ave, Oklahoma City, OK 73107-6412 | 2006-09-20 |
| 1306463617 | Sam's East, Inc. | Technician/Technologist | 5510 Sw 5th St, Oklahoma City, OK 73128-1216 | 2020-07-02 |
| 1407492465 | Sam's East, Inc. | Technician/Technologist | 4101 N May Ave, Oklahoma City, OK 73112-6239 | 2019-11-25 |
| 1205472271 | Sam's East, Inc. | Technician/Technologist | 1900 W Memorial Rd, Oklahoma City, OK 73134-6504 | 2019-11-25 |
| 1134765100 | Sam's East, Inc. | Technician/Technologist | 9000 Nw Passage, Oklahoma City, OK 73132-3414 | 2019-11-25 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73118 |
Please comment or provide details below to improve the information on SAM'S OPTICAL, PENN SQUARE, LLC.
| 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.