Healthcare Provider Details

I. General information

NPI: 1972684991
Provider Name (Legal Business Name): WALMART STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2605
US

IV. Provider business mailing address

702 SW 8TH STREET
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 623-845-8731
  • Fax: 623-845-8733
Mailing address:
  • Phone: 479-277-2500
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH LITTLE
Title or Position: DIRECTOR HEALTHCARE CONTRACTING
Credential:
Phone: 479-277-2500