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SAM'S CLUB OPTICAL
NPI 1154412724
Eyewear Supplier in Granville, WV

Active since September 27, 2006
5045 UNIVERSITY TOWN CENTER DR, GRANVILLE, WV 26501(304) 598-3169(304) 598-3186 Get Directions Write a Review

NPPES record last updated: September 29, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Sam's Club Optical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM'S CLUB OPTICAL (NPI 1154412724), doing business as Sam's Club Optical 30-4936, is a healthcare organization registered as an eyewear supplier in Granville, West Virginia and active in the NPI registry since September 2006. The organization lists Kimberly Canonic, Sr. Director, as its authorized official.

NPPES Registry Identity

NPI1154412724
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSAM'S CLUB OPTICAL
Location Address5045 UNIVERSITY TOWN CENTER DRGranville, WV 26501-2267
Mailing Address1 Customer Dr, Ms 0445Bentonville, AR 72716-0445
Phone(304) 598-3169
Fax(304) 598-3186
Organization SubpartNo
Authorized OfficialKimberly CanonicSr. Director · (480) 853-0515
Enumeration DateSeptember 27, 2006
Last NPPES UpdateSeptember 29, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2025
✔ NPI 1154412724 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition

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

Also ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
5045 UNIVERSITY TOWN CENTER DR, Granville, WV 26501
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Other Names 1

Doing Business AsSam's Club Optical 30-4936

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam's Club Optical's NPI number?

The NPI number for Sam's Club Optical is 1154412724. It was assigned to this organization in the NPPES registry on September 27, 2006. The provider is doing business as Sam's Club Optical 30-4936.

Where is Sam's Club Optical located?

Sam's Club Optical is located at 5045 University Town Center Dr, Granville, WV 26501. The listed phone number is (304) 598-3169.

What is Sam's Club Optical's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

What insurance does Sam's Club Optical accept?

Health plans from Blue Cross and Blue Shield of Louisiana list Sam's Club Optical as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sam's Club Optical was last updated on September 29, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.