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General NPI Number Information
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NPI Number | 1114054517
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Entity Type | Organization
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Legal Business Name | WALMART #2423
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | PARQUE ESCORIAL BO. SAN ANTON STATE RD. #3
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City | CAROLINA
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State | PR
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Zip | 00792-0000
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Country | US
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Telephone | 787-257-0500
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Fax | 787-257-0670
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Provider Business Mailing Address
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Address Line | PARQUE ESCORIAL BO. SAN ANTON STATE RD. #3
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City | CAROLINA
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State | PR
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Zip | 00792-0000
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Country | US
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Telephone | 787-257-0500
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Fax | 787-257-0670
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Authorized Official
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Title or Position | DIR. OF SPECIALTY DIVISIONS
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Name | MR. JORGE L HERNANDEZ
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Credential |
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Telephone | 787-653-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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