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NPI Code Detail

MEDICARE: WAL-MART STORES INC

MEDICARE: WAL-MART STORES INC
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 : 1366721029
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES INC
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-6209
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3497 BETHEL RD SE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5634
Country : US
Telephone Number : 360-874-9060
Fax Number :
Authorized Official
Title or Position : ENROLLMENT SPECIALIST
Name : DIANNA PAINTER
Credential :
Telephone Number : 479-277-1238
Provider Enumeration Date : 08/12/2011
Last Update Date : 08/12/2011

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Directions to “WAL-MART STORES INC ” Practice Location

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