Organization Name: | SAM'S CLUB OPTICAL |
NPI Number: | 1073737441 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHIELA F DOUGLAS (NPI ASSOCIATE) |
Mailing Address: | 29683 Frederick Blvd Daphne |
State: | AL US |
Postal Code: | 36526 |
Phone Number: | 2516266909 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |