MEDICARE: WAL-MART STORES, INC. DBA WAL-MART

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	:	1902937402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES, INC. DBA WAL-MART

Provider Business Mailing Address
First Line	:	702 SW 8TH STREET
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0235
Country	:	US
Telephone Number	:	479-277-9373
Fax Number	:	479-277-8176

Provider Business Practice Location Address
First Line	:	3950 W. LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	479-277-9373
Fax Number	:	479-277-8176

Authorized Official
Title or Position	:	NPI ASSOCIATE
Name	:	DAVID J. SIMMONS
Credential	:
Telephone Number	:	479-277-9373

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	09/11/2025

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