Healthcare Provider Details

I. General information

NPI: 1184872467
Provider Name (Legal Business Name): WAL-MART STORES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 PELHAM RD
GREENVILLE SC
29615-5004
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 864-288-2813
  • Fax: 864-288-2820
Mailing address:
  • Phone: 479-277-1175
  • 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: LAURA LEVINE
Title or Position: DIR., HEALTHCARE CONTRACTING AND EN
Credential:
Phone: 479-204-8550