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General NPI Number Information
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NPI Number | 1073293130
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Entity Type | Organization
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Legal Business Name | WALMART VISION CENTER
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 2101 YOUNTS RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8505
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Country | US
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Telephone | 704-882-8341
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Fax | 704-882-8518
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Provider Business Mailing Address
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Address Line | 2101 YOUNTS RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8505
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Country | US
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Telephone | 704-882-8341
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Fax | 704-882-8518
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID SANTOS
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Credential | LDO
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Telephone | 704-882-8341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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