MEDICARE: WALMART, 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
1	332H00000X	Eyewear Supplier
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1629845227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART, INC.

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-258-2115
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	6675 BUSINESS CENTER DR
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-3603
Country	:	US
Telephone Number	:	303-683-8133
Fax Number	:	303-791-8598

Authorized Official
Title or Position	:	DIRECTOR OF HEALTH CARE CONTRACTING
Name	:	MICHELE GARVEY
Credential	:
Telephone Number	:	479-277-2611

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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Directions to “WALMART, INC. ” Practice Location

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