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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
1332H00000XEyewear Supplier
2156FX1800XOptician

General Provider Information

NPI Number : 1144303702
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 : 72716-0235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4700 135TH ST
Second Line :
City : CRESTWOOD
State : IL
Zip : 60418-1405
Country : US
Telephone Number : 708-489-5547
Fax Number : 708-489-8012
Authorized Official
Title or Position : NPI COORDINATOR
Name : NICOLE D GENTILE
Credential :
Telephone Number : 316-788-5580
Provider Enumeration Date : 10/24/2006
Last Update Date : 03/10/2025

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Directions to “WAL-MART STORES, INC ” Practice Location

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