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NPI Code Detail

MEDICARE: WALMART STORES, INC.

MEDICARE: WALMART 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 : 1518048651
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALMART STORES, INC.
Provider Business Mailing Address
First Line : 1 CUSTOMER DR, MS 0445
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2663 CANYON SPRINGS PKWY
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-0970
Country : US
Telephone Number : 951-653-4849
Fax Number :
Authorized Official
Title or Position : SR. DIRECTOR
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 479-371-1168
Provider Enumeration Date : 10/17/2006
Last Update Date : 10/02/2025

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Directions to “WALMART STORES, INC. ” Practice Location

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