OrganizationActive
Sam'S West, Inc
NPI 1275945255 · Eyewear Supplier · Montgomery, IL
Provider details
- NPI number
- 1275945255
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Parent organization
- Wal-Mart Stores, Inc
- Organization subpart
- Yes
- Authorized official
- Kimberly Canonic, Sr. Director(479) 371-1168
Specialties & taxonomies
Suppliers
- Optician156FX1800X
Eye and Vision Services Providers
Profile Score
Detailed profile(75/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 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
1050 Ogden Ave
Montgomery, IL 60538-5404
Phone: (630) 449-1953
Fax: (630) 449-1954
Street-level locationGet directions
Mailing address
1 Customer Dr
Bentonville, AR 72716-0445
Other names (DBA / former)
- Doing business as
- Sam'S Club Vision Center 30-6388
Registry dates
- Enumerated
- 2014-05-27
- Last updated
- 2025-09-29
- Certified
- 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.