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
1	332H00000X	Eyewear Supplier
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1477125771
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	:	479-258-2080
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	7800 NW EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-1554
Country	:	US
Telephone Number	:	405-773-2625
Fax Number	:	405-773-2636

Authorized Official
Title or Position	:	DIRECTOR, HEALTHCARE CONTRACTING
Name	:	SARAH LITTLE
Credential	:
Telephone Number	:	479-277-2500

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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