Provider Demographics
NPI:1073293130
Name:WALMART VISION CENTER
Entity Type:Organization
Organization Name:WALMART VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:704-882-8341
Mailing Address - Street 1:2101 YOUNTS RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8505
Mailing Address - Country:US
Mailing Address - Phone:704-882-8341
Mailing Address - Fax:704-882-8518
Practice Address - Street 1:2101 YOUNTS RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8505
Practice Address - Country:US
Practice Address - Phone:704-882-8341
Practice Address - Fax:704-882-8518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALMART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty