Organization · Type 2 NPI

Sam's Club Optical

Eyewear Supplier · Nicholasville, KY

NPI number 1295040665 Active

Practice location

103 Bryant Drive
Nicholasville, KY 40356-9225

Call (859) 881-0695 Map

Fax (859) 881-0698

Mailing address

1 Customer Dr, Ms 0445
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Optician	156FX1800X	None listed
Eyewear Supplier Primary	332H00000X	None listed

Eyewear Supplier: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Other eyewear supplier providers in Nicholasville

Wal-Mart Stores East, LPEyewear Supplier Nicholasville, KY NPI 1366522278

See all in Nicholasville →

NPI record

NPI: 1295040665
Entity type: Organization (Type 2)
Issued: Aug 10, 2010
Last updated: Jun 15, 2026
Status: Active
Subpart: Yes of Wal-Mart Stores Inc

Other names

<unavail>
Sam's Club Optical 30-4728 · doing business as
Sam's Optical Center 30-4728 · doing business as

Authorized official

Kimberly Canonic
SR Director
(480) 853-0515

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1295040665

Sam's Club Optical's National Provider Identifier is 1295040665, issued on Aug 10, 2010. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Nicholasville, KY. The record was last updated on Jun 15, 2026.