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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
1156FX1800XOptician
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1790796829
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 : 72716-0235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 555 COLEMANS XING
Second Line :
City : MARYSVILLE
State : OH
Zip : 43040-7042
Country : US
Telephone Number : 937-644-2800
Fax Number :
Authorized Official
Title or Position : CONTRACT COORDINATOR
Name : TAMMY J BOYD
Credential :
Telephone Number : 479-277-1359
Provider Enumeration Date : 08/11/2006
Last Update Date : 09/11/2025

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