Healthcare Provider Details

I. General information

NPI: 1134640071
Provider Name (Legal Business Name): WAL MART STORES TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 STONEBROOK PKWY
FRISCO TX
75034
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 972-987-8768
  • Fax:
Mailing address:
  • Phone: 479-277-2500
  • 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 Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH LITTLE
Title or Position: DIR HEALTHCARE CONTRACTING
Credential:
Phone: 479-277-2500