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NPI Code Detail

MEDICARE: WALMART INC.

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
1332H00000XEyewear Supplier
2156FX1800XOptician

General Provider Information

NPI Number : 1801663596
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 : 1200 N LACROSSE ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6965
Country : US
Telephone Number : 605-348-4881
Fax Number : 605-348-3783
Authorized Official
Title or Position : DIRECTOR OF HEALTH CARE CONTRACTING
Name : MICHELE GARVEY
Credential :
Telephone Number : 479-277-2611
Provider Enumeration Date : 12/04/2023
Last Update Date : 03/08/2024

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