Provider Demographics
NPI:1073641171
Name:WALMART #2072
Entity Type:Organization
Organization Name:WALMART #2072
Other - Org Name:WALMART VISION CENTER #2072
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR. OF SPECIALTY DIVISIONS
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:AVE. LOS VETERANOS
Mailing Address - Street 2:KM 134.7
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-0000
Mailing Address - Country:US
Mailing Address - Phone:787-864-1060
Mailing Address - Fax:787-864-1210
Practice Address - Street 1:AVE. LOS VETERANOS
Practice Address - Street 2:KM 134.7
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0000
Practice Address - Country:US
Practice Address - Phone:787-864-1060
Practice Address - Fax:787-864-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier