Healthcare Provider Details

I. General information

NPI: 1295826253
Provider Name (Legal Business Name): WAL-MART STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7904 S 83RD ST
LAVISTA NE
68128-2774
US

IV. Provider business mailing address

702 SW 8TH ST.
BENTONVILLE AR
72716-0235
US

V. Phone/Fax

Practice location:
  • Phone: 402-597-8990
  • 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: NICOLE D GENTILE
Title or Position: NPI COORDINTOR
Credential:
Phone: 316-788-5580