MEDICARE: WAL-MART STORES EAST, LP

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
1	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114002052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES EAST, LP

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-6209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3247
Country	:	US
Telephone Number	:	863-318-0752
Fax Number	:

Authorized Official
Title or Position	:	NPI COORDINATOR
Name	:	NICOLE D GENTILE
Credential	:
Telephone Number	:	316-788-5580

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1689508277 — ALONDRA RAMOS PEREZ
Practice Location Address:

4141 GIORGIO DR
WINTER HAVEN, FL
33884-3761

Practice Phone: 321-466-6076
Practice Fax: 321-466-6076

1386268894 — DR. ROBERTO ODRACIR REYES DMD
Practice Location Address:

3501 CYPRESS GARDENS RD
WINTER HAVEN, FL
33884-2459

Practice Phone: 863-268-2300
Practice Fax:

1942657796 — DENTAL VIEW, LLC
Practice Location Address:

3501 CYPRESS GARDENS RD
WINTER HAVEN, FL
33884-2459

Practice Phone: 863-268-2300
Practice Fax: 863-268-2399

1538163159 — DONALD EASON M.D.
Practice Location Address:

1119 INTERLOCHEN BLVD
WINTER HAVEN, FL
33884-3707

Practice Phone: 863-289-6060
Practice Fax:

1073519310 — DR. KENNETH A ESSIG M.D.
Practice Location Address:

7599 CYPRESS GARDENS BLVD
WINTER HAVEN, FL
33884-3263

Practice Phone: 863-845-2688
Practice Fax: 863-291-6050

1730185976 — SA-PG-WINTER HAVEN LLC
Practice Location Address:

1120 CYPRESS GARDENS BLVD
WINTER HAVEN, FL
33884-1919

Practice Phone: 863-293-3100
Practice Fax: 863-291-0578

Directions to “WAL-MART STORES EAST, LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.