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General NPI Number Information
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NPI Number | 1629720784
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Entity Type | Organization
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Legal Business Name | WAL-MART STORES EAST , LP
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1801 BELLE ISLE BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-4221
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Country | US
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Telephone | 405-832-9026
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Fax | 405-832-9025
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Provider Business Mailing Address
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Address Line | 702 SW 8TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72716-0445
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Country | US
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Telephone | 479-204-1850
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH CARE CONTRACTING
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Name | SARAH LITTLE
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Credential |
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Telephone | 479-277-2500
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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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Taxonomy #2
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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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