Healthcare Provider Details

I. General information

NPI: 1801010277
Provider Name (Legal Business Name): WAL-MART STORES EAST, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E CHURCH ST
BATESBURG-LEESVILLE SC
29070
US

IV. Provider business mailing address

702 SW 8TH STREET
BENTONVILLE AR
72716-0235
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-5332
  • Fax:
Mailing address:
  • Phone: 479-277-1175
  • Fax: 479-277-8174

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: MISS SABRINA NICOLE SUTTON
Title or Position: NPI ASSOCIATE
Credential:
Phone: 479-277-1175