Organization Name: | SAM'S WEST, INC |
NPI Number: | 1104239904 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURA LEVINE (DIR HEALTHCARE CONTR. & ENROLLMENT) |
Mailing Address: | 6600 44th Ave Moline |
State: | IL US |
Postal Code: | 612658127 |
Phone Number: | 3095817140 |
Fax Number: | 3097643295 |
NPI Enumeration Date: | 06/09/2014 |
NPI Last Update Date: | 06/09/2014 |
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: |