Provider Demographics
NPI:1043494933
Name:WAL-MART STORES TEXAS, LP
Entity Type:Organization
Organization Name:WAL-MART STORES TEXAS, LP
Other - Org Name:WAL-MART OPTICAL HOME OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICAL PROVIDER ENROLLMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WES
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRAINSHAW
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:479-277-1850
Mailing Address - Street 1:702 SW 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0235
Mailing Address - Country:US
Mailing Address - Phone:479-277-1850
Mailing Address - Fax:479-277-8176
Practice Address - Street 1:702 SW 8TH STREET
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-0235
Practice Address - Country:US
Practice Address - Phone:479-277-1850
Practice Address - Fax:479-277-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty