Provider Demographics
NPI:1013041292
Name:WALMAN OPTICAL COMPANY
Entity Type:Organization
Organization Name:WALMAN OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-520-6000
Mailing Address - Street 1:2747 ENTERPRISE AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7412
Mailing Address - Country:US
Mailing Address - Phone:406-252-2143
Mailing Address - Fax:800-759-4920
Practice Address - Street 1:2747 ENTERPRISE AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7412
Practice Address - Country:US
Practice Address - Phone:406-252-2143
Practice Address - Fax:800-759-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000029735OtherDEPT OF CORRECTIONS #
MT5520002OtherCHIP PROVIDER NUMBER
MT0550056Medicaid