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NPI Code Detail

MEDICARE: WALMART INC.

MEDICARE: WALMART 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 : 1417047416
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALMART 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 : 1807 W CRAIG RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0217
Country : US
Telephone Number : 702-633-6521
Fax Number :
Authorized Official
Title or Position : SENIOR DIRECTOR
Name : MICHELE GARVEY
Credential :
Telephone Number : 479-277-2611
Provider Enumeration Date : 10/13/2006
Last Update Date : 10/31/2022

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