Healthcare Provider Details

I. General information

NPI: 1467537035
Provider Name (Legal Business Name): WAL-MART STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W BROMLEY LN
BRIGHTON CO
80601-3026
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-6209
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-1560
  • 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: LINDA M. EPPERSON
Title or Position: NPI COORDINATOR
Credential:
Phone: 316-788-5580