| Organization Name: | SAMS WEST, INC |
| NPI Number: | 1083957054 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEB LAUVER (SPECIALIST PLAN ENROLLMENT) |
| Mailing Address: | 1831 Madison Ave Mankato |
| State: | MN US |
| Postal Code: | 560015449 |
| Phone Number: | 5073878176 |
| Fax Number: | 5073874952 |
| NPI Enumeration Date: | 03/28/2013 |
| NPI Last Update Date: | 03/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |