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NPI Code Detail

MEDICARE: WAL-MART STORES EAST, LP

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
1332H00000XEyewear Supplier
2156FX1800XOptician

General Provider Information

NPI Number : 1679896641
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES EAST, LP
Provider Business Mailing Address
First Line : 702 SW 8TH STREET
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3458 DICKERSON PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37207-2511
Country : US
Telephone Number : 615-865-8181
Fax Number :
Authorized Official
Title or Position : CARRIER SPECIALIST
Name : HOLLY C WILKINSON
Credential :
Telephone Number : 479-204-8320
Provider Enumeration Date : 03/05/2010
Last Update Date : 03/05/2010

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