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
1	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1326129180
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	:	4627 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4879
Country	:	US
Telephone Number	:	801-261-3695
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1023035219 — WALMART INC.
Practice Location Address:

4627 S 900 E
SALT LAKE CITY, UT
84117-4879

Practice Phone: 801-261-3818
Practice Fax:

1225639792 — NINA BARSEGIAN
Practice Location Address:

4627 S 900 E
SALT LAKE CITY, UT
84117-4879

Practice Phone: 801-268-1818
Practice Fax: 801-261-3869

1003417510 — JACOB L SMITH
Practice Location Address:

4627 S 900 E
SALT LAKE CITY, UT
84117-4879

Practice Phone: 801-261-3818
Practice Fax:

1720331499 — PATRICIA POZERNICK
Practice Location Address:

344 EAST 100 SOUTH , SUITE 301
SALT LAKE CITY, UT
84045-4879

Practice Phone: 801-322-4257
Practice Fax:

1184789893 — DR. BERGE MARCARIAN M.D.
Practice Location Address:

4551 W US HIGHWAY 90 , SUITE 101
LAKE CITY, FL
32055-4879

Practice Phone: 386-719-9993
Practice Fax: 386-719-4744

1851456560 — BERGE MARCARIAN, M.D., P.A.
Practice Location Address:

4551 W US HIGHWAY 90 , SUITE 101
LAKE CITY, FL
32055-4879

Practice Phone: 386-719-9993
Practice Fax: 386-719-4744

Directions to “WAL-MART STORES, INC ” 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.