Healthcare Provider Details

I. General information

NPI: 1760657530
Provider Name (Legal Business Name): WAL-MART STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N. K 7 HWY
OLATHE KS
66061-3766
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-7150
  • Fax:
Mailing address:
  • Phone: 479-277-1238
  • 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: DIANNE PAINTER
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 479-277-1238