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NPI Code Detail

MEDICARE: WAL-MART STORES, INC.

MEDICARE: WAL-MART STORES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1073601613
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES, INC.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-277-2500
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 2750 E GERMANN RD
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-1403
Country : US
Telephone Number : 480-812-2930
Fax Number : 480-812-2950
Authorized Official
Title or Position : DIRECTOR HEALTHXCARE CONTRACTING
Name : SARAH LITTLE
Credential :
Telephone Number : 479-277-2500
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/21/2022

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