Healthcare Provider Details

I. General information

NPI: 1306908322
Provider Name (Legal Business Name): WAL-MART STORES EAST, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CATSKILL CMNS
CATSKILL NY
12414
US

IV. Provider business mailing address

702 SW 8TH ST.
BENTONVILLE AR
72716
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-9609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE GARVEY
Title or Position: SR. DIR H&W
Credential:
Phone: 479-277-9170