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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 : 1518204080
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 : 72716-0445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 W FM 646 RD
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-4968
Country : US
Telephone Number : 281-337-9717
Fax Number :
Authorized Official
Title or Position : SPECIALIST, PLAN ENROLLMENT
Name : AMY POWERS
Credential :
Telephone Number : 479-204-0709
Provider Enumeration Date : 01/03/2013
Last Update Date : 01/03/2013

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

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