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
1	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1912085978
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	:	1701 W DOROTHY LN
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45439-1838
Country	:	US
Telephone Number	:	937-643-2124
Fax Number	:

Authorized Official
Title or Position	:	NPI COORDINATOR
Name	:	NICOLE D GENTILE
Credential	:
Telephone Number	:	316-788-5580

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1194571422 — ALEXIS A NEWTON
Practice Location Address:

4420 OVERLAND TRL
KETTERING, OH
45429-1838

Practice Phone: 614-558-4090
Practice Fax:

1619570595 — TAYLOR CUSUMANO
Practice Location Address:

1701 W DOROTHY LN
MORAINE, OH
45439-1838

Practice Phone: 937-643-2481
Practice Fax:

1023035227 — WAL-MART STORES EAST LP
Practice Location Address:

1701 W DOROTHY LN
MORAINE, OH
45439-1838

Practice Phone: 937-643-2481
Practice Fax:

1457952202 — EILAF SHERMADOU RPH, PHARMD
Practice Location Address:

1701 W DOROTHY LN
MORAINE, OH
45439-1838

Practice Phone: 937-643-2481
Practice Fax:

1801645890 — MR. GREGORY SHELDON PACLEB
Practice Location Address:

1701 W DOROTHY LN
MORAINE, OH
45439-1838

Practice Phone: 937-643-2707
Practice Fax:

1568220168 — SARAH HIBBARD
Practice Location Address:

3411 OFFICE PARK DR STE 200
KETTERING, OH
45439-2295

Practice Phone: 937-802-5440
Practice Fax:

Directions to “WAL-MART STORES EAST, LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.