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
1	332H00000X	Eyewear Supplier
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1790614188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART INC

Provider Business Mailing Address
First Line	:	1 CUSTOMER DR
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 E WETMORE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1743
Country	:	US
Telephone Number	:	520-416-7442
Fax Number	:	520-416-7441

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/19/2026

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Directions to “WALMART INC ” Practice Location

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