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NPI Code Detail

MEDICARE: WAL-MART STORES EAST, LP.

MEDICARE: WAL-MART STORES EAST, LP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier
2156FX1800XOptician

General Provider Information

NPI Number : 1134996556
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES EAST, LP.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-258-2115
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 1800 CARL D SILVER PKWY
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-4960
Country : US
Telephone Number : 540-786-8180
Fax Number : 540-548-0053
Authorized Official
Title or Position : DIRECTOR OF HEALTH CARE CONTRACTING
Name : MICHELE GARVEY
Credential :
Telephone Number : 479-277-2611
Provider Enumeration Date : 12/06/2023
Last Update Date : 12/06/2023

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