Healthcare Provider Details

I. General information

NPI: 1396827226
Provider Name (Legal Business Name): WAL-MART STORES EAST, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 9TH ST
KALAMAZOO MI
49009-6594
US

IV. Provider business mailing address

702 SW 8TH STREET
BENTONVILLE AR
72716-0235
US

V. Phone/Fax

Practice location:
  • Phone: 269-544-2952
  • Fax: 269-544-2956
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: LINDA M. EPPERSON
Title or Position: NPI COORDINATOR
Credential:
Phone: 316-788-5580