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	:	1780451781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART, 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	:	3661 TRUXEL RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-3604
Country	:	US
Telephone Number	:	916-928-6095
Fax Number	:	916-419-1196

Authorized Official
Title or Position	:	SR DIRECTOR
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	479-371-1168

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	10/02/2025

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Directions to “WALMART, INC. ” Practice Location

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