Healthcare Provider Details

I. General information

NPI: 1427659226
Provider Name (Legal Business Name): WALMART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 12/27/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8431 S STEWART AVE
CHICAGO IL
60620
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 773-358-9004
  • Fax: 773-783-8843
Mailing address:
  • Phone: 479-277-2500
  • 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: SARAH LITTLE
Title or Position: DIR CONTRACTING
Credential:
Phone: 479-277-2500