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NPI Code Detail

MEDICARE: WAL-MART STORES EAST, LP

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
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1689771115
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 : 72716-0235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1040 MALABAR RD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32907-3251
Country : US
Telephone Number : 321-723-2031
Fax Number :
Authorized Official
Title or Position : CONTRACT COORDINATOR
Name : TAMMY J BOYD
Credential :
Telephone Number : 479-277-1359
Provider Enumeration Date : 09/19/2006
Last Update Date : 09/11/2025

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Directions to “WAL-MART STORES EAST, LP ” Practice Location

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