Healthcare Provider Details

I. General information

NPI: 1811048713
Provider Name (Legal Business Name): WAL-MART VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELMRIDGE CENTER DR
ROCHESTER NY
14626-3459
US

IV. Provider business mailing address

100 ELMRIDGE CENTER DR
ROCHESTER NY
14626-3459
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-2290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNY

VIII. Authorized Official

Name: ONOFRIO SAM MELI
Title or Position: VISION CENTER MANAGER
Credential:
Phone: 585-227-2290