Provider Demographics
NPI:1003942467
Name:WALMART #2067
Entity Type:Organization
Organization Name:WALMART #2067
Other - Org Name:WALMART VISION CENTER #2067
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIALTY DIVISION
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-7777
Mailing Address - Street 1:975 AVE. HOSTOS
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00668-1252
Mailing Address - Country:US
Mailing Address - Phone:787-834-2280
Mailing Address - Fax:787-834-3020
Practice Address - Street 1:MAYAGUEZ MALL
Practice Address - Street 2:STATE RD # 2
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2280
Practice Address - Fax:787-834-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier