Healthcare Provider Details

I. General information

NPI: 1053122804
Provider Name (Legal Business Name): WAL-MART STORES TEXAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 FRY RD
CYPRESS TX
77433-5143
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 832-349-7802
  • Fax:
Mailing address:
  • Phone: 479-371-2827
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DARREN KEITH TOWNZEN
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 479-204-8452