OrganizationActive
Sam'S Club Optical
NPI 1033299417 · Eyewear Supplier · Madison, MS
Provider details
- NPI number
- 1033299417
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Canonic, Sr Director(480) 853-0515
Specialties & taxonomies
Suppliers
- Optician156FX1800X
Eye and Vision Services Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
257 Grandview Blvd
Madison, MS 39110-5514
Phone: (601) 977-0465
Fax: (601) 898-1962
Street-level locationGet directions
Mailing address
1 Customer Dr
Bentonville, AR 72716-0235
Other names (DBA / former)
- Doing business as
- Sam'S Club Optical 30-8271
Registry dates
- Enumerated
- 2006-10-17
- Last updated
- 2026-05-19
- Certified
- 2026-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.