Healthcare Provider Details

I. General information

NPI: 1356726558
Provider Name (Legal Business Name): WAL-MART STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 HIGHWAY 107
SHERWOOD AR
72120-2933
US

IV. Provider business mailing address

702 SW 8TH ST MAILSTOP 0445
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 479-204-8705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LAURA LEVINE
Title or Position: DIR HEALTHCARE ENROLMENT&CONTTRACT
Credential:
Phone: 479-204-8550