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NPI Code Detail

MEDICARE: WAL-MART STORES TEXAS, LLC

MEDICARE: WAL-MART STORES TEXAS, LLC
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
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1194816355
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES TEXAS, LLC
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0629
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 215 E MILE 3 RD
Second Line :
City : PALMHURST
State : TX
Zip : 78573-6677
Country : US
Telephone Number : 956-519-8453
Fax Number :
Authorized Official
Title or Position : MANAGER GOV CONTRACTING
Name : LAURA LEVINE
Credential :
Telephone Number : 479-204-8550
Provider Enumeration Date : 09/27/2006
Last Update Date : 05/28/2013

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Directions to “WAL-MART STORES TEXAS, LLC ” Practice Location

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