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	:	1578984472
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	:	72716-0445
Country	:	US
Telephone Number	:	479-277-2500
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	9260 S HOUGHTON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9732
Country	:	US
Telephone Number	:	520-329-6679
Fax Number	:	520-663-3645

Authorized Official
Title or Position	:	DIR. GOV. CONTRACTING
Name	:	SARAH LITTLE
Credential	:
Telephone Number	:	479-277-2500

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	07/21/2022

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

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