Healthcare Provider Details

I. General information

NPI: 1932976933
Provider Name (Legal Business Name): WALMART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 DAVIS ST
SAN LEANDRO CA
94577-1208
US

IV. Provider business mailing address

1 CUSTOMER DR, MS 0445
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 510-430-9903
  • Fax: 510-430-9340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY CANONIC
Title or Position: SR DIRECTOR
Credential:
Phone: 479-371-1168