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	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1871980219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART INC.

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-258-2115
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	4425 VENETUCCI BLVD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	303-305-2137
Fax Number	:	719-576-3698

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MATTHEW MCMULLIN
Credential	:
Telephone Number	:	479-371-8711

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	12/12/2023

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