OrganizationActive
Sam'S Club Optical
NPI 1154412724 · Eyewear Supplier · Granville, WV
Sam'S Club Optical is a Eyewear Supplier organization in Granville, WV (NPI 1154412724).
Provider details
- NPI number
- 1154412724
- 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
5045 University Town Center Dr
Granville, WV 26501-2267
Phone: (304) 598-3169
Fax: (304) 598-3186
Approximate (ZIP-level) locationGet directions
Mailing address
1 Customer Dr
Bentonville, AR 72716-0445
Other names (DBA / former)
- Doing business as
- Sam'S Club Optical 30-4936
Registry dates
- Enumerated
- 2006-09-27
- Last updated
- 2025-09-29
- Certified
- 2025-09-29
Frequently asked questions
- What is Sam'S Club Optical's NPI number?
- Sam'S Club Optical's National Provider Identifier (NPI) is 1154412724, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Sam'S Club Optical?
- Sam'S Club Optical is classified in the NPPES registry as Eyewear Supplier (Suppliers).
- Where is Sam'S Club Optical located?
- Sam'S Club Optical's practice location on file with NPPES is 5045 University Town Center Dr, Granville, WV 26501-2267.
- What is Sam'S Club Optical's phone number?
- The practice phone number listed in the NPPES registry for Sam'S Club Optical is (304) 598-3169.
- Who is the authorized official for Sam'S Club Optical?
- The authorized official listed on Sam'S Club Optical's NPPES record is Kimberly Canonic, Sr. Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Sam'S Club Optical's NPI active?
- Yes — Sam'S Club Optical's NPI (1154412724) is active in the NPPES registry as of the last update on 2025-09-29.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.