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

General Provider Information

NPI Number	:	1427395995
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	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2347 VETERANS MEMORIAL PKWY S
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9183
Country	:	US
Telephone Number	:	765-477-9395
Fax Number	:

Authorized Official
Title or Position	:	SPECIALIST, PLAN ENROLLMENT
Name	:	AMY POWERS
Credential	:
Telephone Number	:	479-204-0709

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

Similar Medicare Providers

1417041575 — WAL-MART STORES EAST LP
Practice Location Address:

2347 VETERANS MEMORIAL PKWY S
LAFAYETTE, IN
47909-9183

Practice Phone: 765-477-9391
Practice Fax:

1588751721 — CARLA R. TESO, OD, PC, INC
Practice Location Address:

2347 VETERANS MEMORIAL PKWY S
LAFAYETTE, IN
47909-9183

Practice Phone: 765-477-9395
Practice Fax: 765-477-9397

1457992281 — JAVED HUSSAIN SYED DMD
Practice Location Address:

2000 VETERANS MEMORIAL PKWY S
LAFAYETTE, IN
47909-9183

Practice Phone: 765-746-6166
Practice Fax:

1295573665 — DR. LUCY WEN DMD
Practice Location Address:

2000 VETERANS MEMORIAL PKWY S
LAFAYETTE, IN
47909-9183

Practice Phone: 765-746-6166
Practice Fax:

1285562298 — PATRICIA WOLF
Practice Location Address:

6733 NAVIGATOR DR
LAFAYETTE, IN
47909-9311

Practice Phone: 217-898-8734
Practice Fax:

1003784729 — PRIME NUTRITION SOLUTIONS, LLC
Practice Location Address:

6424 S 500 E
LAFAYETTE, IN
47909-9173

Practice Phone: 765-203-1645
Practice Fax: 833-633-4467

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.