Healthcare Provider Details

I. General information

NPI: 1447027990
Provider Name (Legal Business Name): WAL-MART STORES EAST, LP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 BURGESS RD
HARRISONBURG VA
22801-3704
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-9527
  • Fax: 540-442-1833
Mailing address:
  • Phone: 479-258-2115
  • Fax: 479-277-4331

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: MICHELE GARVEY
Title or Position: DIRECTOR OF HEALTH CARE CONTRACTING
Credential:
Phone: 479-277-2611